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Orthopedic Surgery

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Abstract

Introduction: In our study, we aim to characterize the incidence, risk factors, and outcome for and outcomes of upper extremity (UE) neurologic injury following operations for patients with early onset scoliosis (EOS).

Methods:EOS patients who underwent surgical correction of their scoliosis were selected from a multicenter database. The patient cohort was then analyzed in their demographics, etiology of scoliosis, details of the injury, type of spinal implant, and changes in cobb angle and kyphosis. Descriptive statistics were used to summarize this cohort of patients.

Results: Out of 4653 EOS patients who underwent surgery in the multicenter database, 10 patients were identified as having sustained an upper extremity (UE) neurological injury. The average age at surgery was 7.3 years old. Regarding the etiology of EOS, 7 were congenital, 2 were neuromuscular, and 1 was syndromic. Two patients were identified as having a Sprengel’s deformity. VEPTR (50%) was the most common spinal instrumentation, followed by traditional growing rods (20%), and magnetically controlled growing rods (20%). Seventy-eight percent of the superior attachments were hooks on a rib. Upper fixation with pedicle screws were seen in 2 patients. No one had no spinal hook for superior fixation. The average pre-operative and post-operative Cobb angles were 72.3±20.0° and 54.5±12.1°. Six patients’ neurological injury resolved and 4 of them required re-operation for the resolution. Numbness, tingling, and paresthesia of the upper extremity were experienced by 3 patients. Decrease in independent movement of UE or onset of new contractures were experienced by 8 patients.

Conclusions: Upper extremity neurologic injury is a rare but serious potential complication in scoliosis surgeries for EOS patients. Congenital scoliosis patients have the highest risk. Patients with risk factors such as congenital scoliosis and Sprengel’s deformity, should be carefully monitored for upper extremity as well as lower extremity function during corrective surgery.

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Upper Extremity Neurologic Injury following Surgery for Early-Onset Scoliosis

Introduction: In our study, we aim to characterize the incidence, risk factors, and outcome for and outcomes of upper extremity (UE) neurologic injury following operations for patients with early onset scoliosis (EOS).

Methods:EOS patients who underwent surgical correction of their scoliosis were selected from a multicenter database. The patient cohort was then analyzed in their demographics, etiology of scoliosis, details of the injury, type of spinal implant, and changes in cobb angle and kyphosis. Descriptive statistics were used to summarize this cohort of patients.

Results: Out of 4653 EOS patients who underwent surgery in the multicenter database, 10 patients were identified as having sustained an upper extremity (UE) neurological injury. The average age at surgery was 7.3 years old. Regarding the etiology of EOS, 7 were congenital, 2 were neuromuscular, and 1 was syndromic. Two patients were identified as having a Sprengel’s deformity. VEPTR (50%) was the most common spinal instrumentation, followed by traditional growing rods (20%), and magnetically controlled growing rods (20%). Seventy-eight percent of the superior attachments were hooks on a rib. Upper fixation with pedicle screws were seen in 2 patients. No one had no spinal hook for superior fixation. The average pre-operative and post-operative Cobb angles were 72.3±20.0° and 54.5±12.1°. Six patients’ neurological injury resolved and 4 of them required re-operation for the resolution. Numbness, tingling, and paresthesia of the upper extremity were experienced by 3 patients. Decrease in independent movement of UE or onset of new contractures were experienced by 8 patients.

Conclusions: Upper extremity neurologic injury is a rare but serious potential complication in scoliosis surgeries for EOS patients. Congenital scoliosis patients have the highest risk. Patients with risk factors such as congenital scoliosis and Sprengel’s deformity, should be carefully monitored for upper extremity as well as lower extremity function during corrective surgery.

 

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