PMID- 38221840
OWN - NLM
STAT- Publisher
LR  - 20240115
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Linking)
DP  - 2024 Jan 15
TI  - Assessing Neurologic Complications in Thoracic Three-Column Osteotomy: A Clinical 
      Application of a Novel MRI-Based Classification Approach.
LID - 10.1097/BRS.0000000000004924 [doi]
AB  - STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To investigate the 
      occurrence of neurologic complications in patients undergoing thoracic 
      three-column osteotomy (3CO) utilizing an MRI-based classification that assesses 
      spinal cord shape and the presence of cerebrospinal fluid (CSF) at the curve 
      apex, and evaluate its prognostic capacity for postoperative neurologic deficits. 
      SUMMARY OF BACKGROUND DATA: Recent advancements in correction techniques have 
      improved outcomes for severe spinal deformity patients undergoing 3CO. A novel 
      MRI-based spinal cord classification system was introduced, but its validation 
      and association with postoperative complications remain unexplored. MATERIALS AND 
      METHODS: Between September 2012 and September 2018, a retrospective analysis was 
      conducted on 158 adult patients with spinal deformities undergoing 3CO. 
      Radiographic parameters were measured. T2-weighted axial MRI was employed to 
      describe spinal cord morphology at the apex. Intraoperative neurophysiologic 
      monitoring (INOM) alerts were recorded, and preoperative and postoperative 
      neurologic functions were assessed using the Frankel score. Categorical data were 
      compared using the Chi-Square or Fisher's exact test. The paired t-test was 
      utilized to assess the mean difference between pre- and postoperative 
      measurements, while the one-way ANOVA and independent t-test were employed for 
      comparative analyses among the different spinal cord types. RESULTS: Patients 
      were categorized into three groups: type 1, type 2, and type 3, consisting of 12, 
      85, and 61 patients. Patients with type 3 morphology exhibited larger Cobb angles 
      of the main curve (P<.001). This disparity persisted both postoperatively and 
      during follow-up (P<.05). IONM alerts were triggered in 32 patients (20.3%), with 
      a distribution of one case in type 1, six cases in type 2, and 22 cases in type 3 
      morphologies (P<.001). New neurologic deficits were observed in 15 patients 
      (9.5%), with one, three, and 11 cases in type 1, 2, and 3 morphologies, 
      respectively. CONCLUSIONS: Patients with type 3 morphology exhibited greater 
      spinal deformity severity, higher likelihood of preoperative neurologic deficits, 
      and an elevated risk of postoperative neurologic complications. This underscores 
      the utility of the classification as a tool for predicting postoperative 
      neurologic complications in patients undergoing thoracic 3CO. LEVEL OF EVIDENCE: 
      Level IV.
CI  - Copyright (c) 2024 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Lo, Yuan-Shun
AU  - Lo YS
AD  - Division of Spine Surgery, Department of Orthopedic Surgery, China Medical 
      University Hospital, China Medical University, Taichung, Taiwan.
AD  - Division of Spine Surgery, Department of Orthopedic Surgery, China Medical 
      University Beigang Hospital, China Medical University, Yunlin, Taiwan.
FAU - Shi, Ben-Long
AU  - Shi BL
AD  - Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower 
      Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 
      Jiangsu Province, China.
FAU - Lin, Erh-Ti Ernest
AU  - Lin EE
AD  - Division of Spine Surgery, Department of Orthopedic Surgery, China Medical 
      University Hospital, China Medical University, Taichung, Taiwan.
FAU - Yeh, Chen-Wei
AU  - Yeh CW
AD  - Division of Spine Surgery, Department of Orthopedic Surgery, China Medical 
      University Hospital, China Medical University, Taichung, Taiwan.
FAU - Tsai, Chun-Hao
AU  - Tsai CH
AD  - Division of Spine Surgery, Department of Orthopedic Surgery, China Medical 
      University Hospital, China Medical University, Taichung, Taiwan.
FAU - Chen, Hsien-Te
AU  - Chen HT
AD  - Division of Spine Surgery, Department of Orthopedic Surgery, China Medical 
      University Hospital, China Medical University, Taichung, Taiwan.
FAU - Zhu, Ze-Zhang
AU  - Zhu ZZ
AD  - Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower 
      Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 
      Jiangsu Province, China.
FAU - Qiu, Yong
AU  - Qiu Y
AD  - Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower 
      Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 
      Jiangsu Province, China.
LA  - eng
PT  - Journal Article
DEP - 20240115
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
COIS- Conflicts of interest: none to declare.
EDAT- 2024/01/15 06:42
MHDA- 2024/01/15 06:42
CRDT- 2024/01/15 03:06
PHST- 2023/10/11 00:00 [received]
PHST- 2023/12/28 00:00 [accepted]
PHST- 2024/01/15 06:42 [medline]
PHST- 2024/01/15 06:42 [pubmed]
PHST- 2024/01/15 03:06 [entrez]
AID - 00007632-990000000-00556 [pii]
AID - 10.1097/BRS.0000000000004924 [doi]
PST - aheadofprint
SO  - Spine (Phila Pa 1976). 2024 Jan 15. doi: 10.1097/BRS.0000000000004924.