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Delayed Postoperative Neurologic Deficits in Spinal Deformity Surgery
Joshua D Auerbach1, Kristin Kean, Andrew H Milby
1*Department of Orthopaedics, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York†Temple University School of Medicine, Philadelphia, Pennsylvania‡Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania§Norwich Orthopaedic Group, Norwich, Connecticut¶Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania||Department of Orthopedics, Rady Children's Hospital-San Diego, San Diego, California**Department of Orthopaedic Surgery, Shriner's Hospitals for Children - Los Angeles, Los Angeles, California††Department of Orthopaedic Surgery, Mount Sinai Medical Center Beth Israel Hospital, New York, New York.
Delayed postoperative neurologic deficit (DPND) after spinal surgery occurs in 0.01% of cases. Prompt recognition and intervention are crucial, as complete or partial recovery is possible, particularly for compression-related deficits.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Neurology
Background:
- Delayed postoperative neurologic deficit (DPND) is a rare but serious complication following spinal surgery.
- Limited data exists on DPND, with current knowledge primarily from case reports and small series.
Purpose of the Study:
- To determine the incidence of DPND in spinal deformity surgery.
- To characterize the clinical presentation, diagnostic workup, treatment, and neurologic prognosis of DPND.
Main Methods:
- A cross-sectional survey was distributed to surgeon members of the Scoliosis Research Society (SRS).
- The survey collected data on DPND cases, including onset, cause, and patient outcomes.
- A response rate of 38% was achieved, with 352 surgeons participating.
Main Results:
- The estimated incidence of DPND was 0.01% (1 in 9910 cases).
- Most DPND cases (63%) occurred within 24 hours post-surgery, with 90% occurring within 48 hours.
- Ischemic injury (38%) and cord compression (15%) were the most common causes; 41% of patients had complete neurologic recovery, and 26% had partial recovery.
Conclusions:
- DPND is a rare complication with an incidence of 0.01% following spinal deformity surgery.
- Early onset (within 48 hours) is typical, with ischemic injury and cord compression being primary causes.
- Complete or partial neurologic recovery is achievable, especially in compression-related DPND, highlighting the importance of vigilance and prompt intervention.
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