MAJOR INTRAOPERATIVE NEUROLOGIC DEFICITS IN PEDIATRIC AND ADULT SPINAL DEFORMITY PATIENTS - INCIDENCE AND ETIOLOGY AT ONE INSTITUTION

Study Design. A retrospective study of 1,090 patients undergoing corre ctive spinal deformity surgery for scoliosis (n = 920), kyphosis (n = 77), or a combination of the two (n = 93) at one institution. Objectiv es. To ascertain the etiologies and incidence of neurologic deficits o ccurring at the time of surgery. Summary of Background Data. Potential etiologies of intraoperative neurologic deficits include cord compres sion, overdistraction, purely vascular, or combination. Methods. The s tudy group included only patients with useful function of their lower extremities and normal bowel and bladder control, and patients whose s urgeries were in spinal cord territory as opposed to purely cauda equi na territory. Results. There were four major neurologic deficits that occurred during surgery. Three of the four deficits were purely vascul ar in etiology. The fourth may have had a vascular and mechanical etio logy. All four patients had anterior and posterior surgery with harves ting of the unilateral convex segmental vessels, and each had a compon ent of hyperkyphosis, as well as intraoperative controlled hypotension . All four patients showed marked improvement of motor weakness with t ime. Conclusions. Significant risk factors were combined anterior and posterior surgery (P = 0.009) and hyperkyphosis (P = 0.0006).