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Related Experiment Videos

Delayed paraplegia complicating sublaminar segmental spinal instrumentation.

C E Johnston, L T Happel, R Norris

    The Journal of Bone and Joint Surgery. American Volume
    |April 1, 1986
    PubMed
    Summary

    Delayed paraplegia can occur after spinal instrumentation surgery. This may be due to progressive neural edema and implant impingement, even with normal intraoperative spinal cord monitoring.

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    Area of Science:

    • Neurosurgery
    • Spinal Surgery
    • Neurology

    Background:

    • Complex spinal deformities often require multi-stage surgical correction.
    • Segmental spinal instrumentation with sublaminar wiring is a surgical technique used for spinal fusion.

    Observation:

    • Two patients developed delayed paraplegia after spinal instrumentation and fusion.
    • Normal spinal cord monitoring and immediate postoperative motor function were observed.
    • Paraplegia manifested 30 hours to 6 days postoperatively.

    Findings:

    • Delayed paraplegia may result from progressive ischemic and edematous events not detected during surgery.
    • Subarachnoid space obstruction due to neural edema is a likely cause.
    • Sublaminar implants in kyphotic segments may worsen neural irritation via dural impingement.

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    Implications:

    • Current intraoperative spinal cord monitoring may not detect all causes of delayed neurological deficits.
    • Further research is needed to understand and prevent delayed paraplegia after spinal instrumentation.
    • Consideration of implant placement and potential for delayed edema is crucial in high-risk patients.