Assessing Neurological Complications in Thoracic Three-Column Osteotomy: A Clinical Application of a Novel MRI-Based Classification Approach.

Autor:	Lo YS; Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan.; Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Beigang Hospital, China Medical University, Yunlin, Taiwan., Shi BL; Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China., Lin EE; Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan., Yeh CW; Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan., Tsai CH; Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan., Chen HT; Department of Orthopedic Surgery, Division of Spine Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan., Zhu ZZ; Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China., Qiu Y; Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
Jazyk:	angličtina
Zdroj:	Spine [Spine (Phila Pa 1976)] 2024 Jul 01; Vol. 49 (13), pp. 950-955. Date of Electronic Publication: 2024 Jan 15.
DOI:	10.1097/BRS.0000000000004924
Abstrakt:	Study Design: Retrospective comparative study. Objective: To investigate the occurrence of neurological complications in patients undergoing thoracic three-column osteotomy (3CO) utilizing an magnetic resonance imaging (MRI)-based classification that assesses spinal cord shape and the presence of cerebrospinal fluid at the curve apex and evaluate its prognostic capacity for postoperative neurological deficits. Summary of Background Data: Recent advancements in correction techniques have improved outcomes for severe spinal deformity patients undergoing 3CO. A novel MRI-based spinal cord classification system was introduced, but its validation and association with postoperative complications remain unexplored. Materials and Methods: Between September 2012 and September 2018, a retrospective analysis was conducted on 158 adult patients with spinal deformities undergoing 3CO. Radiographic parameters were measured. T2-weighted axial MRI was used to describe spinal cord morphology at the apex. Intraoperative neurophysiological monitoring alerts were recorded, and preoperative and postoperative neurological functions were assessed using the Frankel score. Categorical data were compared using the χ 2 or the Fisher exact test. The paired t test was utilized to assess the mean difference between preoperative and postoperative measurements, while the one-way analysis of variance and independent t test were used for comparative analyses among the different spinal cord types. Results: Patients were categorized into three groups: type 1, type 2, and type 3, consisting of 12, 85, and 61 patients. Patients with type 3 morphology exhibited larger Cobb angles of the main curve ( P <0.001). This disparity persisted both postoperatively and during follow-up ( P <0.05). Intraoperative neurophysiological monitoring alerts were triggered in 32 patients (20.3%), with a distribution of one case in type 1, six cases in type 2, and 22 cases in type 3 morphologies ( P <0.001). New neurological deficits were observed in 15 patients (9.5%), with 1, 3, and 11 cases in type 1, 2, and 3 morphologies, respectively. Conclusions: Patients with type 3 morphology exhibited greater spinal deformity severity, a higher likelihood of preoperative neurological deficits, and an elevated risk of postoperative neurological complications. This underscores the utility of the classification as a tool for predicting postoperative neurological complications in patients undergoing thoracic 3CO. Level of Evidence: 4. Competing Interests: The authors report no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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