Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Aug 1;35(7):310-318.
doi: 10.1097/BSD.0000000000001240. Epub 2021 Aug 2.

Comprehensive Perioperative Approach to Complex Spine Deformity Management

Celeste Camargo  1 , Kingsley Abode-Iyamah  2 , Jaimin S Shah  3 , Perry S Bechtle  4 , William D Freeman  2   3   5
Affiliations
Review

Comprehensive Perioperative Approach to Complex Spine Deformity Management

Celeste Camargo et al. Clin Spine Surg. .

Abstract

Objective: Study perioperative strategies for optimizing neuroprotection in complex spine deformity correction surgery.

Methods: We report the case of a patient with severe lumbar dextroscoliosis, thoracolumbar junction hyperkyphosis with a 40-degree Cobb angle levoconvex scoliosis who underwent spinal deformity correction with loss of neuromonitoring during surgery. We performed a literature review on perioperative management of complex spine deformity.

Results: A 50-year-old man presented with lumbar pain and right L4 radiculopathy. Surgical intervention for deformity correction and decompression was indicated with T4-L4 posterior instrumentation L2/L3 and L3/L4 transforaminal lumbar interbody fusion. Surgery was aborted due to the loss of neuromonitoring. Postsurgery, the patient had left sensory deficit and the neurocritical care team clinically suspected and deduced the anatomic location of the spinal cord compression. Magnetic resonance imaging confirmed a T10-T11 hyperintensity suggestive of cord ischemia due to osteophyte compressing the spinal cord. The patient underwent a second corrective surgery with no intraoperative events and has no long-term neurological sequela.

Conclusions: This case illustrates that a comprehensive perioperative approach and individualized risk factor assessment is useful in complex spine deformity surgery. Further research is needed to determine how this individualized comprehensive approach can lead to intraoperative and postoperative countermeasures that improved spine surgery outcomes.

Level of evidence: Level V.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Graham RB, Cotton M, Koht A, et al. Loss of intraoperative neurological monitoring signals during flexed prone positioning on a hinged open frame during surgery for kyphoscoliosis correction: case report. J Neurosurg Spine. 2018;29:339–343.
    1. Acosta FL Jr, McClendon J Jr, O’Shaughnessy BA, et al. Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors. J Neurosurg Spine. 2011;15:667–674.
    1. Kelly MP, Lenke LG, Shaffrey CI, et al. Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study. Neurosurg Focus. 2014;36:E17.
    1. DePasse JM, Palumbo MA, Haque M, et al. Complications associated with prone positioning in elective spinal surgery. World J Orthop. 2015;6:351–359.
    1. Sethi RK, Pong RP, Leveque JC, et al. The Seattle spine team approach to adult deformity surgery: a systems-based approach to perioperative care and subsequent reduction in perioperative complication rates. Spine Deform. 2014;2:95–103.