Abstract
Background Context
Thoracic costotransversectomies (TCT) are amongst the most invasive spine procedures
performed. Of greatest concern to the patient and surgeon is the risk of iatrogenic
neurologic injury associated with these procedures. Most available studies limit their
assessment of neurologic function to nonspecific scales such as the broader ASIA scoring
system of A to E and have not comprehensively described the rates of iatrogenic injury
following these procedures by looking more precisely with ASIA motor scoring (0–100)
which allows for more in-depth analysis.
Purpose
The purpose of this study is to investigate the rates and degree of iatrogenic neurologic
decline following TCT and subsequent rates and degree of motor recovery.
Study Design/Setting
Retrospective medical record review at a single institution.
Patient Sample
Around 116 consecutive patients undergoing TCT operations.
Outcome Measures
Neurological changes from preprocedure to final follow-up assessed by lower extremity
motor score.
Methods
A retrospective chart review of patients undergoing TCT between May 2008 and April
2018 was carried out. Clinical, surgical, and intraoperative neuromonitoring data
were collected. Patients who demonstrated an initial postoperative decline in lower
extremity motor scores (LEMS) were followed through their final follow up to assess
recovery.
Results
Around 116 patients underwent TCT between T2 and T12 between May 2008 and April 2018.
Seven (6.0%) patients demonstrated an immediate postoperative decline as defined by
a drop of more than 4 points (mean 15.1; range 5–50) in motor score. All patients
who demonstrated an initial postoperative motor score decline returned to within 4
LEMS points of their preoperative LEMS by final follow up. IOMN changes were noted
only in half of all monitored patients who were noted to have a decline.
Conclusions
In our series, 6.0% of patients undergoing TCT experienced an initial decline in motor
score with 94.0% demonstrating an unchanged or improved examination compared to preoperative
exam. In our series, all patients who exhibited a decline recovered to within 4 points
of the preoperative motor score within the first year postoperatively.
Keywords
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Article info
Publication history
Published online: January 12, 2021
Accepted:
January 11,
2021
Received in revised form:
December 21,
2020
Received:
October 9,
2020
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: ANEN: Nothing to disclose. CT: Nothing to disclose. JA: Nothing to disclose. HZ: Nothing to disclose. CB: Nothing to disclose. RJB: Speaking and/or Teaching Arrangements: Globus (C), AO Spine (B); Fellowship Support: AO Spine (E).
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
