Femoral head to lower lumbar neural foramen distance as a novel radiographic parameter to predict postoperative stretch neuropraxia

View More View Less
  • 1 Department of Orthopedic Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

OBJECTIVE

Lumbosacral fractional curves in adult spinal deformity (ASD) patients often have sharp coronal curves resulting in significant pain and imbalance. Postoperative stretch neuropraxia after fractional curve correction can lead to discomfort and unsatisfactory outcomes. The goal of this study was to use radiographic measures to increase understanding of the relationship between postoperative stretch neuropraxia and fractional curve correction.

METHODS

In 62 ASD patients treated from 2015 to 2018, radiographic review was performed, including measurement of the distance between the lower lumbar neural foramen (L4 and L5) in the concavity and convexity of the lumbosacral fractional curve and the ipsilateral femoral heads (FHs; L4–FH and L5–FH) in pre- and postoperative anteroposterior spine radiographs. The largest absolute preoperative to postoperative change in distance between the lower lumbar neural foramen and the ipsilateral FH (ΔL4/L5–FH) was used for analysis. Chi-square analyses, independent and paired t-tests, and logistic regression were performed to study the relationship between L4/L5–FH and stretch neuropraxia for categorical and continuous variables, respectively.

RESULTS

Of the 62 patients, 13 (21.0%) had postoperative stretch neuropraxia. Patients without postoperative stretch neuropraxia had an average ΔL4–FH distance of 16.2 mm compared to patients with stretch neuropraxia, who had an average ΔL4–FH distance of 31.5 mm (p < 0.01). Patients without postoperative neuropraxia had an average ΔL5–FH distance of 11.1 mm compared to those with stretch neuropraxia, who had an average ΔL5–FH distance of 23.0 mm (p < 0.01). Chi-square analysis showed that patients had a 4.78-fold risk of developing stretch neuropraxia with ΔL4–FH > 20 mm (95% CI 1.3–17.3) and a 5.17-fold risk of developing stretch neuropraxia with ΔL5–FH > 15 mm (95% CI 1.4–18.7). Logistic regression analysis indicated that the odds of developing stretch neuropraxia were 15:1 with a ΔL4–FH > 20 mm (95% CI 3–78) and 21:1 with a ΔL5–FH > 15 mm (95% CI 4–113).

CONCLUSIONS

The novel ΔL4/L5–FH distances are strongly associated with postoperative stretch neuropraxia in ASD patients. A ΔL4–FH > 20 mm and ΔL5–FH > 15 mm significantly increase the odds for patients to develop postoperative stretch neuropraxia.

ABBREVIATIONS

ASD = adult spinal deformity; FH = femoral head; IONM = intraoperative neuromonitoring; LL = lumbar lordosis; LS = lumbosacral; L1S1 = L1–S1 Cobb angle; ODI = Oswestry Disability Index; PCO = posterior column osteotomy; PI = pelvic incidence; SRS = Scoliosis Research Society; SS = sacral slope; SVA = sagittal vertical axis; TLIF = transforaminal lumbar interbody fusion; TL/L = thoracolumbar/lumbar.

Illustrations from Hubbe et al. (pp 160–163). Copyright Ioannis Vasilikos and Roberto Ferrarese. Published with permission.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Wang TP, Zheng ZM, Liu H, et al. Correlation of adult spinal sagittal imbalance and life quality. Article in Chinese. Zhonghua Yi Xue Za Zhi. 2012;92(21):14811485.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Bridwell KH, Lewis SJ, Edwards C, et al. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine (Phila Pa 1976). 2003;28(18):20932101.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Lenke LG, Fehlings MG, Shaffrey CI, et al. Neurologic outcomes of complex adult spinal deformity surgery: results of the prospective, multicenter Scoli-RISK-1 study. Spine (Phila Pa 1976). 2016;41(3):204212.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Buchowski JM, Bridwell KH, Lenke LG, et al. Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine (Phila Pa 1976). 2007;32(20):22452252.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Kim SS, Cho BC, Kim JH, et al. Complications of posterior vertebral resection for spinal deformity. Asian Spine J. 2012;6(4):257265.

  • 6

    Bradford DS, Tribus CB. Vertebral column resection for the treatment of rigid coronal decompensation. Spine (Phila Pa 1976). 1997;22(14):15901599.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Cho KJ, Suk SI, Park SR, et al. Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2007;32(20):22322237.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Rustagi T, Tallarico RA, Lavelle WF. Early lumbar nerve root deficit after three column osteotomy for fixed sagittal plane deformities in adults. Int J Spine Surg. 2018;12(2):131138.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Iorio JA, Reid P, Kim HJ. Neurological complications in adult spinal deformity surgery. Curr Rev Musculoskelet Med. 2016;9(3):290298.

  • 10

    Kim HJ, Iyer S, Zebala LP, et al. Perioperative neurologic complications in adult spinal deformity surgery: incidence and risk factors in 564 patients. Spine (Phila Pa 1976). 2017;42(6):420427.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Swamy G, Berven SH, Bradford DS. The selection of L5 versus S1 in long fusions for adult idiopathic scoliosis. Neurosurg Clin N Am. 2007;18(2):281288.

  • 12

    Cho KJ, Suk SI, Park SR, et al. Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis. Eur Spine J. 2009;18(4):531537.

  • 13

    Horton WC, Holt RT, Muldowny DS. Controversy. Fusion of L5-S1 in adult scoliosis. Spine (Phila Pa 1976). 1996;21(21):25202522.

  • 14

    Emami A, Deviren V, Berven S, et al. Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine (Phila Pa 1976). 2002;27(7):776786.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Edwards CC II, Bridwell KH, Patel A, et al. Thoracolumbar deformity arthrodesis to L5 in adults: the fate of the L5-S1 disc. Spine (Phila Pa 1976). 2003;28(18):21222131.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Edwards CC II, Bridwell KH, Patel A, et al. Long adult deformity fusions to L5 and the sacrum. A matched cohort analysis. Spine (Phila Pa 1976). 2004;29(18):19962005.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Campbell PG, Nunley PD. The challenge of the lumbosacral fractional curve in the setting of adult degenerative scoliosis. Neurosurg Clin N Am. 2018;29(3):467474.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Quan X, Guo K, Wang Y, et al. Mechanical compression insults induce nanoscale changes of membrane-skeleton arrangement which could cause apoptosis and necrosis in dorsal root ganglion neurons. Biosci Biotechnol Biochem. 2014;78(10):16311639.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 199 199 199
Full Text Views 71 71 71
PDF Downloads 123 123 123
EPUB Downloads 0 0 0