Neurologic Injury in Pediatric Scoliotic Deformity Correction, pp. 535-548
Authors: Ahmet Yılmaz Şarlak and Bilgehan Tosun
Abstract: There is an insufficient extent of data concerning the rate of neurological complications in scoliosis correction. Multiple risk factors related to the aethiology and pattern of deformity as well as direct trauma by the surgical procedure are known causes. The chord is potentially at risk in the correction of congenital kyphoscoliosis, adult scoliosis and in curves with increased rigidity. Either through mechanical or ischemic damage, the ultimate pathogenic event is a secondary cellular injury beginning in the damaged level. Neurologic complications may be divided into peripheral, cord and central types. As secondary surgical interventions as well as high dose steroids only have limited success once iatrogenic damage to the cord occurred; increasing hope had been directed to medical prevention. Different systems of neurologic monitoring by means of somatosensory and motor evoked potentials and wake-up test have been established to detect intra-operative deterioration of neurologic function. Promising steps lie in methods of sitimulating reinnervation through growth factors or in the area of stem cell research.