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Neurologic Injury in the Surgical Treatment of Idiopathic Scoliosis: Guidelines for Assessment and Management

Dr. Guille or a member of his immediate family serves as a board member, owner, officer, or committee member of The Pediatric Orthopaedic Society of North America, the Scoliosis Research Society, and the Eastern Orthopaedic Association; is affiliated with the publication Orthopedics; and is a member of a speakers’ bureau or has made paid presentations on behalf of and is a paid consultant or an employee of Medtronic Sofamor Danek. Dr. Samdani or a member of his immediate family is a member of a speakers’ bureau or has made paid presentations on behalf of DePuy, Stryker, and Spinevision; serves as a paid consultant to DePuy and Spinevision; and has received research or institutional support from DePuy. Dr. Betz or a member of his immediate family has received royalties from DePuy, Osteotech, Medtronic Sofamor Danek, Synthes, Spinevision, and Osteotech; serves as a paid consultant to or is an employee of DePuy, Medtronic Sofamor Danek, Osteotech, Spinevision, Synthes, Orthovita, NuVasive, Omrix, Spinemedica, and Orthocon; has received research or institutional support from DePuy and Synthes; and has stock or stock options held in Orthocon and Spinemedica. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Pahys, Dr. D’Andrea, and Dr. Beck.

Dr. Pahys is Chief Resident, Albert Einstein Medical Center, Philadelphia, PA. Dr. Guille is Co-Director, Division of Spinal Disorders, and Director of Pediatric Orthopaedic Surgery, Brandywine Institute of Orthopaedics, Pottstown, PA. Dr. D’Andrea is Co-Director, Division of Spinal Disorders, Brandywine Institute of Orthopaedics. Dr. Samdani is Director of Spinal Surgery, Shriners Hospital for Children, Philadelphia. Dr. Beck is Spine Surgeon, Teton Orthopaedics, Jackson Hole, WY. Dr. Betz is Chief of Staff and Medical Director, Spinal Cord Injury Unit, Shriners Hospital for Children, Philadelphia.

Reprint requests: Dr. Guille, Brandywine Institute of Orthopaedics, Suite 611, 600 Creekside Drive, Pottstown, PA 19464.

Iatrogenic spinal cord injury resulting from surgical treatment of spinal deformity is a relatively uncommon but devastating complication. Publications on the prevalence of spinal cord injury following surgery are numerous, but no definitive review with clinically pertinent treatment guidelines exists. Methods to reduce the risk of neurologic complications with scoliosis surgery include adequate patient evaluation and preoperative planning, intraoperative preparation, intraoperative neuromonitoring, and postoperative management. Treatment algorithms may be useful in the clinical setting to manage intraoperative or postoperative neurologic injury.