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Is deformity correction essential in a "Myelopathic Cord"? - A case series
1Department of Spine Services, Indian Spinal Injuries Centre, Sector-C, Vasant Kunj, New Delhi, 110070, India.
Spinal Cord Series and Cases
|August 20, 2024
Summary
Pediatric spinal deformity with neurological deficits is challenging. Decompressive surgery and stabilization, prioritizing neurological recovery over deformity correction, led to significant improvement in four pediatric cases.
Area of Science:
- Pediatric spinal surgery
- Neurological recovery
- Spinal cord decompression
Background:
- Pediatric spinal deformities with neurological deficits present a significant surgical challenge.
- Preoperative neurological deficits increase the risk of postoperative deficits, complicating management.
- The study addresses the management of pediatric spinal deformities with myelopathic cords.
Observation:
- Four pediatric cases with myelopathic cords and severe neurological deficits (Nurick grade 4 or 5) were treated.
- Treatment involved circumferential decompression and posterior pedicle screw stabilization without deformity correction.
- Intraoperative neuromonitoring was employed to prevent neurological worsening.
Findings:
- All patients experienced significant neurological recovery (Nurick grade 0 to 2).
- No progression of spinal deformity was observed during follow-up (up to 4 years).
- Patients showed good improvement in the SRS22r questionnaire domains.
Implications:
- Prioritizing neurological recovery over immediate deformity correction is crucial in managing pediatric spinal deformities with myelopathy.
- Decompressive surgery and stabilization can lead to favorable neurological outcomes.
- Deformity correction can be considered at a later stage under neuromonitoring.
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