Neuro-vaskuläre Komplikationen bei komplexen Korrektureingriffen − Ursachen, Prävention, Systemlösungen

Zusammenfassung

Die Autoren präsentieren eine ausführliche Übersichtsarbeit, welche Einblicke in die Pathogenese, Prävention und Therapie neurovaskulärer Komplikationen in der Behandlung komplexer spinaler Pathologien ermöglicht. Insbesondere werden die strategischen Grundzüge für die Vermeidung neurologischer Läsionen bei Patienten mit komplexen Deformitäteneingriff an der Wirbelsäule und mit neurologische erhöhten Risiko dargestellt.

Abstract

The authors present a comprehensive review article on the pathogenesis, the prevention strategies and the treatment options for surgery and spinal deformity correction in patients with elevated risk for neuromuscular related complications. In particularly, strategic concepts for prevention of neurologic deficits related to spinal ischemia during surgical spinal interventions are highlighted.

• Literatur

• 1 Chen Z, Zeng Y, Li W. et al. Apical segmental resection osteotomy with dual axial rotation corrective technique for severe focal kyphosis of the thoracolumbar spine. J Neurosur Spine 2011; 14: 106-113
• 2 Laratta JL, Ha A, Shillingford JN. et al. Neuromonitoring in Spinal Deformity Surgery: A Multimodality Approach. Global Spine J 2018; 8: 68-77
• 3 Marks DS, Qaimkhani SA. The natural history of congenital scoliosis and kyphosis. Spine 2009; 34: 1751-1755
• 4 Jarvis JG, Strantzas S, Lipkus M. et al. Responding to neuromonitoring changes in 3-column posterior spinal osteotomies for rigid pediatric spinal deformities. Spine 2013; 13: E493-503
• 5 Wagner SC, Lehmann Jr RA, Lenke L. Posterior verebtral column resection (VCR) for complex spinal deformities. Springer; 2015
• 6 Zhang BB, Zhang T, Tao HR. et al. Neurological complications of thoracic posterior vertebral column resection for severe congenital spinal deformities. Eur Spine J 2017; 26: 1871-1877
• 7 Weiss HR, Goodall D. Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature. Scoliosis 2008; 3: 9
• 8 Sacramento-Domínguez C, Yagi M, Ayamga J. FOCOS Spine Research Group. et al. Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications?. Spine J 2015; 15: 2351-2359
• 9 Yang C, Zheng Z, Liu H. et al. Posterior vertebral column resection in spinal deformity: a systematic review. Eur Spine J 2016; 25: 2368-2375
• 10 Koller H, Meier O. Operative Aufrichtung von Kyphosen. Georg Thieme Verlag; Stuttgart, New York: 2017
• 11 Hamilton DK, Smith JS, Sansur CA. et al. Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee. Spine (Phila Pa 1976) 2011; 36: 1218-1228
• 12 Simon MJK, Halm HFH, Quante M. Perioperative complications after surgical treatment in degenerative adult de novo scoliosis. BMC Musculoskelet Disord 2018; 19: 10
• 13 Bridwell KH, Glassman S, Horton W. et al. Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976) 2009; 34: 2171-2178
• 14 Reames DL, Smith JS, Fu KM. et al. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine (Phila Pa 1976) 2011; 36: 1484-1491
• 15 Smith JS, Sansur CA, Donaldson 3rd WF. et al. Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 2011; 36: 958-964
• 16 Ayvaz M, Alanay A, Yazici M. et al. Safety and efficacy of posterior instrumentation for patients with congenital scoliosis and spinal dysraphism. J Pediatr Orthop 2007; 27: 380-386
• 17 Kaspiris A, Grivas TB, Weiss HR. et al. Surgical and conservative treatment of patients with congenital scoliosis: alpha search for long-term results. Scoliosis 2011; 6: 12
• 18 Cramer GD, Darby SA. Basic and clinical anatomy of the spine, spinal cord, and ANS. Elsevier Health Sciences; 2005
• 19 Lang J. Clinical Anatomy of the Cervical Spine. Georg Thieme Verlag; Stuttgart, New York: 1993
• 20 Rickenbacher J, Landolt AM, Theiler K. Praktische Anatomie. Rücken.. Springer; 2003
• 21 Thron AK. Vascular Anatomy of the Spinal Cord. Springer Science & Business Media; 2012
• 22 Schade JP. The Peripheral Nervous System. Elsevier; 1966
• 23 Könönen M, Rade M, Marttila J. et al. In Vivo MRI Measurement of Spinal Cord Displacement in the Thoracolumbar Region of Asymptomatic Subjects with Unilateral and Sham Straight Leg Raise Tests. PLoS one 2016; 11: 1-14
• 24 Koller H, Koller J, Mayer M. et al. Osteotomies in Ankylosing Spondylitis: Where, how many, and how much?. Eur Spine J 2018; 27: 70-100
• 25 Winestone JS, Farley CW, Curt BA. et al. Laminectomy, durotomy, and piotomy effects on spinal cord intramedullary pressure in severe cervical and thoracic kyphotic deformity: a cadaveric study. J Neurosur Spine 2012; 16: 195-200
• 26 Li X, Huang Z, Deng Y. et al. Three-dimensional translations following posterior three-column spinal osteotomies for the correction of severe and stiff kyphoscoliosis. Spine J 2017; 17: 1803-1811
• 27 Kawahara N, Tomita K, Kobayashi T. et al. Influence of acute shortening on the spinal cord: an experimental study. Spine 2005; 30: 613-620
• 28 Molinari RW, Bridwell KH, Lenke LG. et al. Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. Spine 1999; 24: 1701-1711
• 29 Ruf M, Melcher R, Merk H. et al. Anatomische Reposition und monosegmentale Fusion bei hochgradiger dysplastischer Spondylolisthese L5/S1. Z Orthop Ihre Grenzgeb 2006; 144: 33-39
• 30 Dafrawy MH, Brooks JT, Kebaish NF. et al. Outcomes and complications of surgical treatment for high-grade spondylolisthesis in adult patients. 2016 51st meeting of SRS, Prague/Tschech Republic
• 31 Haschtmann D, Schär R, Sutter M. et al. Die Prognose der L5-Radikulopathie nach Reposition und instrumentierter Spondylodese bei hochgradigen isthmischen, lumbosakralen Spondylolisthesen und die Rolle des multimodalen intraoperativen Neuromonitorings. Annual Meeting of German Spine Society Frankfurt 2015
• 32 Koller H. Prediction of Surgical Outcomes and Complications with Reduction of High-Grade Spondylolisthesis. 2015 IMAST 2015, Kuala Lumpur, Malaysia
• 33 Moreaua SS, Lonjona G, Guiguia P. et al. Reduction and fusion in high-grade L5 – S1 spondylolisthesis by a single posterior approach. Results in 50 patients. Orthops & Traumatol 2015; 102: 233-237
• 34 Tilan J, Andras LM, Krieger MD. et al. Return of motor evoked potentials after knee flexion in the setting of high-grade spondylolisthesis. Eur Spine J 2017; 26: 619-622
• 35 Kato S, Fehlings MG, Lenke LG. et al. Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study. The Spine J 2018; 18: 1733-1740
• 36 Lewis ND, Keshen SG, Lenke LG. et al. The Deformity Angular Ratio: Does It Correlate With High-Risk Cases for Potential Spinal Cord Monitoring Alerts in Pediatric 3-Column Thoracic Spinal Deformity Corrective Surgery?. Spine 2015; 40: E879-885
• 37 Wang XB, Lenke LG, Thuet E. et al. Deformity Angular Ratio Describes the Severity of Spinal Deformity and Predicts the Risk of Neurologic Deficit in Posterior Vertebral Column Resection Surgery. Spine 2016; 41: 1447-1455
• 38 Rajasekaran S, Bhushan M, Aiyer S. et al. Accuracy of pedicle screw insertion by AIRO^® intraoperative CT in complex spinal deformity assessed by a new classification based on technical complexity of screw insertion. Eur Spine J 27: 2339-2347
• 39 Lewis SJ, Wong IHY, Strantzas S. et al. Responding to Intraoperative Neuromonitoring Changes During Pediatric Coronal Spinal Deformity Surgery. Global Spine J 2019; 9: 15S-21S
• 40 Grande AW, Maher PC, Morgan CJ. et al. Vertebral column subtraction osteotomy for recurrent tethered cord syndrome in adults: a cadaveric study. J Neurosur Spine 2006; 4: 478-484
• 41 Hsieh PC, Stapleton CJ, Moldavskiy P. et al. Posterior vertebral column subtraction osteotomy for the treatment of tethered cord syndrome: review of the literature and clinical outcomes of all cases reported to date. Neurosurg Focus 2010; 29: E6
• 42 Arlet V. Spinal osteotomy in the presence of massive lumbar epidural scarring. Eur Spine J 2015; 23 (Suppl. 01) S93-106
• 43 Safain MG, Burke SM, Riesenburger RI. et al. The effect of spinal osteotomies on spinal cord tension and dural buckling: a cadaveric study. J Neurosur Spine 2015; 23: 120-127
• 44 Kato S, Kawahara N, Tomita K. et al. Effects on spinal cord blood flow and neurologic function secondary to interruption of bilateral segmental arteries which supply the artery of Adamkiewicz: an experimental study using a dog model. Spine 2008; 33: 1533-1541
• 45 Vallespir GP, Barrios C, Flores JJB. et al. Effect of root section and induced hypotension on spinal cord displacement limits durign spine surgery. Experimental study in pigs. 2011 Annual meeting of socliosis research society Louisville/USA
• 46 Zhao Z, Xie J, Bi N. et al. The Changes of SEP/MEP following Ligating Spinal Cord Segmental Vessels in Applying Posterior Vertebral Column Resection (PVCR) to Correct Severe Rigid Spinal Deformity. 2014 Annual meeting of scoliosis research society, Anchorage/USA
• 47 Xie J, Wang Y, Zhao Z. et al. Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100°. J Neurosur Spine 2012; 17: 540-551
• 48 Cheng CW, Chang KW, Chen HC. et al. Correction Hinge in the compromised cord for severe and rigid angular kyphosis with neurologic deficits. Spine 2009; 34: 1040-1045
• 49 Tsirikos AI, Howitt SP, McMaster MJ. Segmental vessel ligation in patients undergoing surgery for anterior spinal deformity. J Bone Joint Surg 2008; 90: 474-479
• 50 Apel DM, Marrero G, King J. et al. Avoiding paraplegia during anterior spinal surgery. The role of somatosensory evoked potential monitoring with temporary occlusion of segmental spinal arteries. Spine 1991; 16: S36570
• 51 Gum JL, Lenke LG, Bumpass D. et al. Does Planned Staging for Posterior-Only Vertebral Column Resections in Spinal Deformity Surgery Increase Perioperative Complications?. Spine Deform 2016; 4: 131-137
• 52 Huang JH, Yang WZ, Shen C. et al. Surgical Treatment of Congenital Scoliosis Associated With Tethered Cord by Thoracic Spine-shortening Osteotomy Without Cord Detethering. Spine 2015; 40: E1103-1109
• 53 Chen B, Yuan Z, Chang MS. et al. Safety and Efficacy of One-stage Spinal Osteotomy for Severe and Rigid Congenital Scoliosis Associated with Split Spinal Cord Malformation. Spine 2015; 40: 1005-1013
• 54 Hui H, Tao HR, Jiang XF. et al. Safety and efficacy of 1-stage surgical treatment of congenital spinal deformity associated with split spinal cord malformation. Spine 2012; 37: 2104-2113
• 55 Koller H, Zenner J, Gajic V. et al. The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature. European Spine Journal 2012; 21: 514-529
• 56 Wang Y, Xie J, Zhao Z. et al. Preoperative short-term traction prior to posterior vertebral column resection: procedure and role. Eur Spine J 2016; 25: 687-697
• 57 Wiedenhöfer BKoller H, Wessel F. et al. Surgical scoliosis correction in patients with Syringomyelia: A study of surgical results in assessment of spinal column length and trunk height changes. 2014 Annual meeting of scoliosis research society, Lion/France
• 58 Rade M, Könönen M, Marttila J. et al. In Vivo MRI Measurement of Spinal Cord Displacement in the Thoracolumbar Region of Asymptomatic Subjects with Unilateral and Sham Straight Leg Raise Tests. PLoS one 2016; 11: e0155927
• 59 Yang J, Skaggs DL, Chan P. et al. Raising Mean Arterial Pressure Alone Restores 20 % of Intraoperative Neuromonitoring Losses. Spine 2018; 43: 890-894
• 60 Vitale MG, Skaggs DL, Pace GI. et al. Best Practices in Intraoperative Neuromonitoring in Spine Deformity Surgery: Development of an Intraoperative Checklist to Optimize Response. Spine Deform 2014; 2: 333-339
• 61 Bhagat S, Durst A, Grover H. An evaluation of multimodal spinal cord monitoring in scoliosis surgery: a single centre experience of 354 operations. Eur Spine J 2015; 24: 1399-1407
• 62 Langeloo DD, Lelivelt A, Louis Journee H. et al. Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients. Spine 2003; 28: 1043-1050
• 63 Anderson PA, Resnick DK, Kaiser MG. Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy. Neurosurg Spine 2009; 11: 245-252
• 64 Sharan A, Groff MW, Dailey AT. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 15: electrophysiological monitoring and lumbar fusion. J Neurosur Spine 2014; 21: 102-105
• 65 Yaylali I, Ju H, Yoo J. et al. Intraoperative neurophysiological monitoring in anterior lumbar interbody fusion surgery. J Clin Neurophysiol 2014; 31: 352-355
• 66 Meyer B, Shiban E, Stoffel M. et al. Intraoperatives neurophysiologisches Monitoring (IOM) in der Wirbelsäulenchirurgie. Die Wirbelsäule 2017; 01: 203-218
• 67 Hong JT, Kim CH, Chung CK. et al. Intraoperative electrophysiological monitoring during posterior craniocervical distraction and realignment for congenital craniocervical anomaly. Eur Spine J 2015; 24: 671-678
• 68 Park P, Wang AC, Sangala JR. et al. Impact of multimodal intraoperative monitoring during correction of symptomatic cervical or cervicothoracic kyphosis. J Neurosur Spine 2011; 14: 99-105
• 69 Appel S, Korn A, Biron T. et al. Efficacy of Head Repositioning in Restoration of Electrophysiological Signals During Cervical Spine Procedures. J Clin Neurophysiol 2017; 34: 174-178
• 70 Hamilton DK, Smith JS, Sansur CA. Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee. Spine 2011; 36: 1218-1228
• 71 Sutter M, Eggspuehler A, Jeszenszky D. et al. The impact and value of uni- and multimodal intraoperative neurophysiological monitoring (IONM) on neurological complications during spine surgery: a prospective study of 2728 patients. Eur Spine J 2018; 28 [Epub ahead of print]
• 72 Thirumala PD, Huang J, Thiagarajan K. et al. Diagnostic accuracy of combined multimodality SSEP and TcMEP intraoperative monitoring in patients with idiopathic scoliosis. Spine 2016; 41: E1177-1184
• 73 Thuet ED, Winscher JC, Padberg AM. Validity and reliability of intraoperative monitoring in pediatric spinal deformity surgery: a 23-year experience of 3436 surgical cases. Spine 2010; 35: 1880-1886
• 74 Raynor BL, Padberg AM, Lenke LG. et al. Failure of Intraoperative Monitoring to Detect Postoperative Neurologic Deficits: A 25-year Experience in 12,375 Spinal Surgeries. Spine 2016; 41: 942-950
• 75 Gavaret M, Pesenti S, Choufani E. Intraoperative spinal cord monitoring in children under 4 years old. Eur Spine J 2016; 25: 1847-1854
• 76 Tobert DG, Glotzbecker MP, Hresko MT. et al. Efficacy of Intraoperative Neurophysiologic Monitoring for Pediatric Cervical Spine Surgery. Clin Spine Surg 2017; 30: 94-101
• 77 Ushirozako H, Yoshida G, Kobayashi S. et al. Impact of total propofol dose during spinal surgery: anesthetic fade on transcranial motor evoked potentials. J Neurosur Spine 2019; 8: 1-9
• 78 Kusin DJ, Ahn UM, Ahn NU. The Effect of Smoking on Spinal Cord Healing Following Surgical Treatment of Cervical Myelopathy. Spine 2015; 40: 1391-1396
• 79 Matisoff AJ, Olivieri L, Schwartz JM. et al. Risk assessment and anesthetic management of patients with Williams syndrome: a comprehensive review. Pediatr Anaesthesia 2015; 25: 1207-1215
• 80 Yang C, Wang H, Zheng Z. et al. Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis. Eur Spine J 2017; 26: 1810-1816
• 81 Lenke LG, Li XJ, Thuet E. et al. Prone Position-Induced Quadriceps Transcranial Motor Evoked Potentials Signal Loss-A Case Report. Spine Deform 2018; 6: 627-630
• 82 Martirosyan NL, Feuerstein JS, Theodore N. et al. Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions. J Neurosurg Spine 2011; 15: 238-251
• 83 To M, Cheung JPYC, Zhu F. et al. Preoperative Traction, Riluzole, and 3D Moeling optimizes the safety of correction of a stiff 150°-degree kyphoscoliosis deformity. 2018 Annual Meeting of SRS, Bologna/Italy
• 84 Ogilvie JW. Complications in spondylolisthesis surgery. Spine (Phila Pa 1976) 2005; 30: S97-101
• 85 Fairbank J, Frost H, Wilson-MacDonald J. et al. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 2005; 330: 1233
• 86 Fritzell P, Hagg O, Wessberg P. et al. Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine (Phila Pa 1976) 2002; 27: 1131-1141
• 87 Sailhan F, Gollogly S, Roussouly P. The radiographic results and neurologic complications of instrumented reduction and fusion of high-grade spondylolisthesis without decompression of the neural elements: a retrospective review of 44 patients. Spine (Phila Pa 1976) 2006; 31: 161-169 ; discussion 170
• 88 Ruf M, Koch H, Melcher RP. et al. Anatomic reduction and monosegmental fusion in high-grade developmental spondylolisthesis. Spine (Phila Pa 1976) 2006; 31: 269-274
• 89 Bridwell KH, Lenke LG, Baldus C. et al. Major intraoperative neurologic deficits in pediatric and adult spinal deformity patients. Incidence and etiology at one institution. Spine (Phila Pa 1976) 1998; 23: 324-331
• 90 Coe JD, Arlet V, Donaldson W. et al. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 2006; 31: 345-349
• 91 Takahashi S, Delecrin J, Passuti N. Surgical treatment of idiopathic scoliosis in adults: an age-related analysis of outcome. Spine (Phila Pa 1976) 2002; 27: 1742-1748
• 92 Vigneswaran HT, Grabel ZJ, Eberson CP. et al. Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20,346 patients. J Neurosurg Pediatr 2015; 16: 322-328
• 93 Smith JS, Shaffrey CI, Klineberg E. et al. Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up. J Neurosurg Spine 2017; 27: 444-457
• 94 Voos K, Boachie-Adjei O, Rawlins BA. Multiple vertebral osteotomies in the treatment of rigid adult spine deformities. Spine (Phila Pa 1976) 2001; 26: 526-533
• 95 Coe JD, Smith JS, Berven S. et al. Complications of spinal fusion for scheuermann kyphosis: a report of the scoliosis research society morbidity and mortality committee. Spine (Phila Pa 1976) 2010; 35: 99-103
• 96 Lonner BS, Toombs CS, Guss M. et al. Complications in operative Scheuermann kyphosis: do the pitfalls differ from operative adolescent idiopathic scoliosis?. Spine (Phila Pa 1976) 2015; 40: 305-311
• 97 Kim YJ, Otsuka NY, Flynn JM. et al. Surgical treatment of congenital kyphosis. Spine (Phila Pa 1976) 2001; 26: 2251-2257
• 98 Koller H, Juliane Z, Umstaetter M. et al. Surgical treatment of Scheuermannʼs kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases. Eur Spine J 2014; 23: 180-191
• 99 Finocchiaro FM, Nena U, Lo Scalzo V. et al. Treatment of kyphotic deformities in adults: our experience. Eur Spine J 2012; 21 (Suppl. 01) S100-107
• 100 Rumalla K, Yarbrough CK, Pugely AJ. et al. Spinal fusion for pediatric neuromuscular scoliosis: national trends, complications, and in-hospital outcomes. J Neurosurg Spine 2016; 25: 500-508
• 101 Turturro F, Montanaro A, Calderaro C. et al. Rate of complications due to neuromuscular scoliosis spine surgery in a 30-years consecutive series. Eur Spine J 2017; 26: 539-545
• 102 Cognetti D, Keeny HM, Samdani AF. et al. Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database. Neurosurg Focus 2017; 43: E10
• 103 Toll BJ, Samdani AF, Janjua MB. et al. Perioperative complications and risk factors in neuromuscular scoliosis surgery. J Neurosurg Pediatr 2018; 22: 207-213
• 104 Smith JS, Shaffrey CI, Berven S. et al. Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976) 2009; 34: 1693-1698
• 105 Auerbach JD, Lenke LG, Bridwell KH. et al. Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine (Phila Pa 1976) 2012; 37: 1198-1210