Incidence and degrees of neurologic decline following thoracic costotransversectomy

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: Anterior vertebral body reconstruction; Iatrogenic injury; Intraoperative neuromonitoring; Spinal cord injury; Thoracic corpectomy; Thoracic costotransversectomy; Thoracic surgery.