Surgical outcomes in patients with spinal deformities associated with neurological deficit
- Authors: Kuleshov A.A.1, Nazarenko A.G.1, Krupatkin A.I.1, Militsa I.M.1, Vetrile M.S.1, Strunina U.V.2, Makarov S.N.1, Lisyansky I.N.1, Sharov V.A.1
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Affiliations:
- N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
- N.N. Burdenko National Medical Research Center of Neurosurgery
- Issue: Vol 32, No 2 (2025)
- Pages: 361-374
- Section: Original study articles
- URL: https://journal-vniispk.ru/0869-8678/article/view/314744
- DOI: https://doi.org/10.17816/vto656745
- EDN: https://elibrary.ru/NHRTEA
- ID: 314744
Cite item
Abstract
BACKGROUND: The surgical treatment in patients with spinal deformities associated with neurological deficit remains a subject of debate. Existing research is mostly limited to case-control studies or case series, with no statistical assessment of treatment outcomes. The absence of a standardized surgical approach and the scarcity of statistically significant outcome data highlight the relevance of further research into this topic.
AIM: The work aimed to assess treatment efficacy in patients with spinal deformities associated with neurological deficit.
METHODS: A retrospective analysis of surgical treatment outcomes was conducted in 51 patients with spinal deformities associated with neurological deficit. Patients were divided into three groups based on the surgical technique used. All patients underwent standard diagnostic examinations. Based on CT myelography findings, individualized 3D models of the spine and spinal cord were created (n = 23), and customized implants were manufactured (n = 8). Patient questionnaires were used, and neurological status was assessed using the Frankel, ASIA, and FIM scales.
RESULTS: A significant regression of neurological deficit was observed in patients classified as Frankel B, C, or D. Motor function improved within days after surgery, whereas sensory function improved on average within six months. Spinal cord decompression at the site of maximal stenosis was found to be a key factor influencing neurological deficit regression.
CONCLUSION: Postoperative neurological deficit regression is determined by its severity and duration prior to surgery, as well as adequate spinal cord decompression at the site of maximal spinal stenosis. Patient-specific 3D models of the spine and spinal cord are a valuable tool for assessing local spinal cord compression.
Full Text
##article.viewOnOriginalSite##About the authors
Alexander A. Kuleshov
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: cito-spine@mail.ru
ORCID iD: 0000-0002-9526-8274
SPIN-code: 7052-0220
MD, Dr. Sci. (Medicine)
Russian Federation, 10 Priorova st, Moscow, 127299Anton G. Nazarenko
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: nazarenkoag@cito-priorov.ru
ORCID iD: 0000-0003-1314-2887
SPIN-code: 1402-5186
Corresponding Member of the Russian Academy of Sciences, MD, Dr. Sci. (Medicine), professor of RAS
Russian Federation, 10 Priorova st, Moscow, 127299Alexander I. Krupatkin
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: krup.61@mail.ru
ORCID iD: 0000-0001-5582-5200
SPIN-code: 3671-5540
MD, Dr. Sci. (Medicine), professor
Russian Federation, 10 Priorova st, Moscow, 127299Igor M. Militsa
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Author for correspondence.
Email: igor.milica@mail.ru
ORCID iD: 0009-0005-9832-316X
SPIN-code: 4015-8113
MD
Russian Federation, 10 Priorova st, Moscow, 127299Marchel S. Vetrile
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: vetrilams@cito-priorov.ru
ORCID iD: 0000-0001-6689-5220
SPIN-code: 9690-5117
MD, Cand. Sci. (Medicine)
Russian Federation, 10 Priorova st, Moscow, 127299Uliya V. Strunina
N.N. Burdenko National Medical Research Center of Neurosurgery
Email: ustrunina@nsi.ru
ORCID iD: 0000-0001-5010-6661
SPIN-code: 9799-5066
MD
Russian Federation, MoscowSergey N. Makarov
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: moscow.makarov@gmail.com
ORCID iD: 0000-0003-0406-1997
SPIN-code: 2767-2429
MD, Cand. Sci. (Medicine)
Russian Federation, 10 Priorova st, Moscow, 127299Igor N. Lisyansky
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: lisigornik@list.ru
ORCID iD: 0000-0002-2479-4381
SPIN-code: 9845-1251
MD, Cand. Sci. (Medicine)
Russian Federation, 10 Priorova st, Moscow, 127299Vladislav A. Sharov
N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics
Email: sharov.vlad397@gmail.com
ORCID iD: 0000-0002-0801-0639
SPIN-code: 8062-9216
MD, Cand. Sci. (Medicine)
Russian Federation, 10 Priorova st, Moscow, 127299References
- Goel SA, Neshar AM, Chhabra HS. A rare case of surgically managed multiple congenital thoraco-lumbar and lumbar block vertebrae with kypho-scoliosis and adjacent segment disease with myelopathy in a young female. Journal of Clinical Orthopaedics and Trauma. 2020;11(2):291–294. doi: 10.1016/j.jcot.2019.04.017
- Matee S, Ayaz SB, Bashir U. Progressive thoracic kyphoscoliosis leading to paraplegia in a child with neurofibromatosis type-1. Journal of the College of Physicians and Surgeons Pakistan. 2021;31(1):98–100. doi: 10.29271/jcpsp.2021.01.98
- Ulrikh EV, Mushkin AYu, Gubin AV. Congenital spine deformities in children: epidemiological prognosis and management. Russian Journal of Spine Surgery. 2009;(2):055–061. doi: 10.14531/ss2009.2.55-61
- Novikov VV, Kolesov SV, Ryabykh SO, et al. Surgical management of neurologically complicated kyphoscoliosis using transposition of the spinal cord: Case report. International Journal of Surgery Case Reports. 2016;27:13–17. doi: 10.1016/j.ijscr.2016.07.037
- Sugimoto Y, Ito Y, Tomioka M, et al. Cervical cord injury in patients with ankylosed spines: Progressive paraplegia in two patients after posterior fusion without decompression. Spine. 2009;34(23):E861–E863. doi: 10.1097/BRS.0b013e3181bb89fc
- Lonstein JE, Akbarnia BA, Boachie-Adjei O, et al. Neurologic deficits secondary to spinal deformity: A review of the literature and report of 43 cases. Spine. 1980;5(4):331–355. doi: 10.1097/00007632-198007000-00007
- Song KS, Chang BS, Yeom JS, et al. Surgical treatment of severe angular kyphosis with myelopathy: Anterior and posterior approach with pedicle screw instrumentation. Spine. 2008;33(11):1229–1235. doi: 10.1097/BRS.0b013e31817152b3
- Shamji MF, Ames CP, Smith JS, et al. The association of cervical spine alignment with neurologic recovery in a prospective cohort of patients with surgical myelopathy: Analysis of a series of 124 cases. World Neurosurgery. 2016;86:112–119. doi: 10.1016/j.wneu.2015.09.044
- Khokhlova O.I. Rehabilitation potential of personality and functional independence of persons with traumatic spinal cord injury. Politravma. 2020;(3):100–107. doi: 10.24411/1819-1495-2020-10038 EDN: CLWSXA
- Maxwell AKE. Spinal cord traction producing an ascending, reversible, neurological deficit: Case report. Verhandlungen der Anatomischen Gesellschaft. 1967;115:49–69.
- Ransohoff J, Spencer F, Siew F, et al. Case reports and technical notes. Journal of Neurosurgery. 1969;31:459–461.
- Vetrile ST, Kuleshov AA. Surgical treatment of severe progressive forms of scoliosis: simultaneous intervention on the ventral and dorsal spine using instrumentation Cotrel-Dubousset. N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(3):14–20. (in Russ.).
- Kuleshov AA, Vetrile MS, Lisyansky IN, et al. Urgical treatment of a patient with congenital deformity of the spine, the thoracic and lumbar pedicle aplasia, and spinal compression syndrome. Russian Journal of Spine Surgery. 2016;13(3):41–48. doi: 10.14531/ss2016.3.41-48 EDN: WKYPBR
- Ailon T, Smith JS, Shaffrey CI, et al. Progressive spinal kyphosis in the aging population. Neurosurgery. 2015;77(Suppl 4):S164–S172. doi: 10.1227/NEU.0000000000000944
- Dommisse GF. The blood supply of the spinal cord: A critical vascular zone in surgery. The Journal of Bone and Joint Surgery. 1974;56(2):225–235.
- Kleinberg S, Kaplan A. Scoliosis complicated by paraplegia. The Journal of Bone and Joint Surgery. 1952;34-A(1):162–7.
- Masini M, Maranhão V. Experimental determination of the effect of progressive sharp-angle spinal deformity on the spinal cord. European Spine Journal. 1997;6(2):89–92. doi: 10.1007/BF01358738
- McMaster MJ, Singh H. Natural history of congenital kyphosis and kyphoscoliosis: A study of one hundred and twelve patients. The Journal of Bone and Joint Surgery. American Volume. 1999;81(10):1367–1383. doi: 10.2106/00004623-199910000-00002
- Saito M. Anterolateral decompression for thoracic myelopathy due to severe kyphosis using the costotransversectomy approach. Rinsho Seikei Geka. 1997;32:523–530.
- Shimode M, Kojima T, Sowa K. Spinal wedge osteotomy by a single posterior approach for correction of severe and rigid kyphosis or kyphoscoliosis. Spine. 2002;27(20):2260–2267. doi: 10.1097/00007632-200210150-00015
- Wilcox B, Smith JA, Brown MJ, et al. Systematic review of 3D printing in spinal surgery: The current state of play. Journal of Spine Surgery. 2017;3(3):433–443. doi: 10.21037/jss.2017.09.01
- Borzunov DYu, Shevtsov VI, Stogov MV, Ovchinnikov EN. Analysis of the experience of carbon nanostructured implants use in traumatology and orthopaedics. N.N. Priorov Journal of Traumatology and Orthopedics. 2016;(2):77–81. EDN: WGESGN
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