Perioperative major neurologic deficits as a complication of spine surgery

Retrospective review of spine surgery patients with new major neurologic complication.

To define the causes and severity of new neurologic damage to the spinal cord or cauda equina caused by spinal surgery.

Consult records were reviewed for all postoperative spine surgery patients referred to a tertiary spinal cord injury rehabilitation center over a 12-year period. Any patients with a new perioperative surgery-related decrement in American Spinal Injury Association (ASIA) Impairment Scale (AIS), loss of bowel or bladder function, or loss of ability to ambulate were examined and final 1-year gaps for neurologic loss reported.

64 patients had a new perioperative major neurologic event with: 41% thoracic, 39% cervical, and 20% lumbar; 61% intraoperative, 31% in the immediate 2-week postoperative period, 8% unknown. Chronic myelopathy (44%) was the most common indication. The causes of neurologic injury were postoperative fluid collection (25%), malposition of instrumentation (14%), traumatic decompression (14%), cord infarct (11%), deformity correction (2%), and unknown (34%). Overall, 87% lost the ability to ambulate and 66% lost volitional bowel-bladder control. AIS decrement and loss of ambulation and bowel-bladder function did not differ statistically significantly by surgical indication. However, among the main root causes, traumatic decompressions and cord infarcts had significantly worse neurologic deterioration than fluid collections or malposition of instrumentation.

The relative rate of major neurologic injury in spine surgery is higher in thoracic and cervical cases at spinal cord levels, especially when done for myelopathy, even though lumbar surgeries are most common. The most common causes of neurologic injury were potentially avoidable postoperative fluid collections, malposition of instrumentation, and traumatic decompression.