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A proposed classification system for guiding surgical strategy in cases of severe spinal deformity based on spinal cord function

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Abstract

Purpose

Spinal cord function classification systems are not useful for guiding surgery in patients with severe spinal deformities. The aim of this study is to propose a classification system for determining a surgical strategy that minimizes the risk of neurological dysfunction in patients with severe spinal deformities.

Methods

The records of 89 patients with severe spinal deformities treated with vertebral column reconstruction from 2008 to 2013 were retrospectively analyzed. Based on neurophysiological monitoring, magnetic resonance imaging, and neurological symptoms patients were categorized into three groups: group A, normal spinal cord, normal evoked potentials and no neurological symptoms; group B, spinal cord abnormalities and/or abnormal evoked potentials but no neurological symptoms; group C, neurological symptoms with or without spinal cord abnormalities/abnormal evoked potentials. Outcomes and complications were compared between the groups.

Results

A total of 89 patients (51 male, 38 female) were included with 47 (52.8 %), 16 (18.0 %), and 26 (29.2 %) patients in groups A, B and C, respectively, and a mean follow-up 34.5 months. There were no differences in age, gender, average preoperative scoliosis, and kyphosis among three groups, but there were differences with respect to the causes of severe spinal deformity and the corrective rate of scoliosis and kyphosis. Changes in intraoperative evoked potentials were different in these three types according to this new classification, and the recovery rates of changes in the three groups were 71.1, 50.0, and 14.1 %, respectively. Postoperative spinal cord injury was positively related to intraoperative changes of evoked potentials.

Conclusion

The classification system may be useful for guiding surgical decisions in patients with severe spinal deformities to minimize the risk of neurological complications.

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    Authors and Affiliations

    1. Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, NO. 58, Zhongshan Er Road, Guangzhou, Guangdong, China

      Jun-lin Yang, Zi-fang Huang, Jun-qiang Yin, Yao-long Deng, Xian-biao Xie, Fo-bao Li & Jing-fan Yang

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    1. Jun-lin Yang
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    2. Zi-fang Huang
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    3. Jun-qiang Yin
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    4. Yao-long Deng
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    Correspondence to Jun-lin Yang.

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    Funding

    This work was supported by grants from Sun Yat-Sen University Clinical Research 5010 Program (No. 2012003). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    Conflict of interest

    The authors declare that they have no competing interests.

    Additional information

    J. Yang and Z. Huang have contributed equally to this work.

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    Yang, Jl., Huang, Zf., Yin, Jq. et al. A proposed classification system for guiding surgical strategy in cases of severe spinal deformity based on spinal cord function. Eur Spine J 25, 1821–1829 (2016). https://doi.org/10.1007/s00586-015-4367-2

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    • DOI: https://doi.org/10.1007/s00586-015-4367-2

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