[Neurologic complications of surgery for spinal deformities]

Most of the neurological complications subsequent to surgery for spinal deformations involve medullar damage, which may be irreversible and sometimes dramatic. We reviewed 667 surgical cases of spinal deformations treated over a 10 year period (1980-1990) and found 33 complications including 19 directly related to the material. There were 7 peripheral complications due to radiculalgia, 3 meningeal complications and 17 medullary complications including 11 paraplegias. Factors influencing the rate of medullary complications (2.5%) and their course were the secondary aetiology of the curvature, a kyphosis component of the spinal deformation and especially the notion of a spinal cord at risk. Emphasis is placed on the delay to development of medullary complications which are particularly severe when they occur late and the relationship between the severity of the neurology syndrome and its course. The problem of material ablation in emergency situations is discussed. Since this series was analyzed, systematic surveillance with PES, the fact that several dangerous techniques such as sublaminal wiring have been abandoned, and more experience with CD implants have considerably reduced the rate of these complications.