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Secondary Spinal Cord Injury llI: Pathophysiology01:25

Secondary Spinal Cord Injury llI: Pathophysiology

Early Ischemia and Ionic ImbalanceWithin minutes of spinal cord injury, a secondary cascade begins, progressing over hours to weeks. Vascular damage reduces blood flow, causing ischemia and mitochondrial dysfunction. ATP depletion leads to ion pump failure, membrane depolarization, sodium influx, potassium efflux, and water accumulation, resulting in cellular swelling. Increased intracellular calcium further disrupts mitochondria and accelerates cellular injury.Excitotoxicity and Neuronal...

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Delayed-Onset Neurologic Changes Following Posterior Spinal Fusion: A Case Series.

Nicholas D Fletcher1, Hilary Harris1, Jorge Fabregas1

  • 1Children's Healthcare of Atlanta, Atlanta, Georgia.

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|February 14, 2025
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Summary
This summary is machine-generated.

Delayed-onset neurologic changes (DONCs) after spinal deformity surgery are rare but devastating. Postoperative hypotension is a key modifiable risk factor, and prompt management may improve outcomes.

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Area of Science:

  • Neurosurgery
  • Spinal Surgery
  • Neurology

Background:

  • Delayed-onset neurologic changes (DONCs) following spinal deformity surgery are poorly understood and can be devastating.
  • This study addresses the limited knowledge regarding DONCs after complex spinal procedures.

Purpose of the Study:

  • To investigate the clinical and radiographic characteristics of patients experiencing DONCs after spinal deformity correction.
  • To identify potential risk factors and outcomes associated with DONCs.

Main Methods:

  • Retrospective review of 18 patients from 12 hospitals who developed DONCs after spinal deformity correction.
  • Evaluation of clinical, radiographic, and intraoperative neuromonitoring data.
  • Analysis of blood pressure, surgical interventions, and neurological recovery.

Main Results:

  • DONCs occurred within 24 hours postoperatively in 78% of patients.
  • Hypotension was documented in 50% of patients around the time of neurologic change.
  • Spinal cord infarcts occurred in 39%, leading to poor recovery (ASIA score B or less), while patients without infarcts showed significant recovery.

Conclusions:

  • DONCs are rare but severe complications of spinal deformity surgery.
  • Postoperative hypotension may be a primary modifiable risk factor.
  • Management may involve blood pressure support and potential implant removal to improve neurological recovery.