Neurological complications in scoliosis surgery: A systematic review of the problem
https://doi.org/10.14531/ss2026.1.6-15
Abstract
The objective of the review is a multi-aspect study of the problem of neurological complications in scoliosis surgery, based on large arrays of literary data (eLibrary, Pubmed). The following aspects of the problem were studied: the incidence of neurological complications in scoliosis surgery, the incidence of neurological complications in scoliosis of various etiologies, the incidence of neurological complications in different age groups, the incidence of neurological complications following various surgical approaches, the frequency of functional recovery after the development of neurological deficit, the causes of neurological complications, risk factors for the development of neurological symptoms, damage to the peripheral nervous system, late development of neurological complications (delayed deficit), and rare complications (casuistry). Neurological complications of surgical interventions for spinal deformities of various etiologies develop relatively infrequently, but this circumstance in no way simplifies the problem, since these complications are sometimes catastrophically severe and require long-term and complex treatment, the success of which is not guaranteed. Surgical treatment of patients with spinal pathology (not just deformities) should be performed in highly specialized centers equipped with the most modern equipment and staffed by highly trained specialists.
About the Authors
M. V. Mikhaylovskiy
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Novosibirs, Russia
Russian Federation
Russian Federation
Mikhail Vitalyevich Mikhaylovskiy, MD, Dr. Dci. (Medicine), Professor; 17 Frunze str., Novosibirsk, 630091, Russia.
A. V. Buzunov
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Novosibirs, Russia
Russian Federation
Russian Federation
Aleksei Vladimirovich Buzunov, MD, Cand. Sci. (Medicine)
A. E. Simonovich
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan, Novosibirs, Russia
Russian Federation
Russian Federation
Alexandr Evgenyevich Simonovich, MD, Dr. Dci. (Medicine), Professor
References
1. Harrington PR. Treatment of scoliosis. Correction and internal fixation by the spine instrumentation. J Bone Joint Surg Am. 1962;44-A:591–610.
2. MacEwen GD, Bunnell WP, Sriram K. Acute neurological complications in the treatment of scoliosis. A report of the Scoliosis Research Society. J Bone Joint Surg Am. 1975;57:404–408.
3. Bridwell KH, Lenke LG, Baldus K, Blanke K. Major intraoperative neurologic deficits in pediatric and adult spinal deformity patients. Incidence and etiology at one institution. Spine (Phila Pa 1976). 1998;23:324–331. DOI: 10.1097/00007632-199802010-00008
4. Winter RB. Neurologic safety in spinal deformity surgery. Spine (Phila Pa 1976). 1997;22:1527–1533. DOI: 10.1097/00007632-199707010-00022
5. Reames DL, Smith JS, Fu KM, Polly DW Jr, Ames CP, Berven SH, Perra JH, Glassman SD, McCarthy RE, Knapp RD Jr, Heary R, Shaffrey CI. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the SRS Morbidity and Mortality Database. Spine (Phila Pa 1976). 2011;36:1484–1491. DOI: 10.1097/BRS.0b013e3181f3a326
6. Qui Y, Wang S, Wang B, Yu Y, Zhu F, Zhu Z. Incidence and risk factors of neurological deficit of surgical correction for scoliosis: analysis of 1373 cases at one Chinese institution. Spine (Phila Pa 1976). 2008;33:519–526. DOI: 10.1097/BRS.0b013e3181657d93
7. Fu KM, Smith JS, Polly DW, Ames CP, Berven SH, Perra JH, Glassman SD, McCarthy RE, Knapp DR, Shaffrey CI. Morbidity and mortality associated with spinal surgery in children: a review of the Scoliosis Research Society morbidity and mortality database. J Neurosurg Pediatr. 2011;7:37–41. DOI: 10.3171/2010.10.PEDS10212
8. Smith JS, Sansur CA, Donaldson WF 3rd, Perra JH, Mudiyam R, Choma TJ, Zeller RD, Knapp DR Jr, Noordeen HH, Berven SH, Goytan MJ, Boachie-Adjei O, Shaffrey CI. Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity. A report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976). 2011;36:958–964. DOI: 10.1097/BRS.0b013e3181eabb26
9. Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D. Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. Spine (Phila Pa 1976). 2012;37:693–700. DOI: 10.1097/BRS.0b013e31822ff5c1
10. Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD, Shah SA, Sides BA, Blanke KM. Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine (Phila Pa 1976). 2013;38:119–132. DOI: 10.1097/BRS.0b013e318269fab1
11. Kim HJ, Iyer S, Zebala LP, Kelly MP, Sciubba D, Protopsaltis TS, Gupta M, Neuman BJ, Mundis GM, Ames CP, Smith JS, Hart R, Burton D, Klineberg EO. Perioperative neurologic complications in adult spinal deformity surgery: incidence and risk factors in 564 patients. Spine (Phila Pa 1976). 2017;42:420–427. DOI: 10.1097/BRS.0000000000001774
12. Fehling MG, Kato S, Lenke LG, Nakashima H, Nagoshi N, Shaffrey CI, Cheung KMC, Carreon L, Dekutoski MB, Schwab FJ, Boachie-Adjei O, Kebaish KM, Ames CP, Qiu Y, Matsuyama Y, Dahl BT, Mehdian H, Pellis-Urquiza F, Lewis SJ, Berven SH. Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study. Spine J. 2018;18:1733–1740. DOI: 10.1016/j.spinee.2018.02.001
13. GuiGui P, Blamoutier A. Les complicasions du traitement chirurgical des deviations rachidiennes: Etude prospective multicentrique d’une cohort de 3311 patients. Rev Chir Orthop Repatrice Appar Mot. 2005;91:314–327. DOI: 10.1016/s0035-1040(05)84329-6
14. Coe JD, Arlet V, Donaldson W, Berven S, Hanson DS, Mudiyam R, Perra JH, Shaffrey CI. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976). 2006;31:345–349. DOI: 10.1097/01.brs.0000197188.76369.13
15. Diab M, Smith A, Kuklo TR. Neural complications in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2007;32:2759–2763. DOI: 10.1097/BRS.0b013e31815a5970
16. Patil CG, Santarelli J, Lad SP, Ho C, Tian W, Boakye M. Inpatients complications, mortality and discharge disposition after surgical correction of idiopathic scoliosis: a national perspective. Spine J. 2008;8:904–910. DOI: 10.1016/j.spinee.2008.02.002
17. Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW Jr, Perra JH, Boachie-Adjei O, Shaffrey CI. Scoliosis Research Society morbidity and mortality of adult scoliosis surgery. Spine (Phila Pa 1976). 2011;36:E593–E597. DOI: 10.1097/BRS.0b013e3182059bfd
18. Lykissas MG, Jain VV, Nathan ST, Pawar V, Eismann EA, Sturm PF, Crawford AH. Mid-to long-term outcomes in adolescent idiopathic scoliosis after instrumented posterior spinal fusion: a meta-analysis. Spine (Phila Pa 1976). 2013;38:E113–E119. DOI: 10.1097/BRS.0b013e31827ae3d0
19. Gauthier LE, Mandourah Y, Soroceanu A, McIntosh AL, Flynn JM, El-Hawary R. Perioperative neurologic injury associated with rib-based distraction surgery. Spine Deform. 2014;2:481–488. DOI: 10.1016/j.jspd.2014.08.003
20. Skovrlj B, Cho SK, Caridi JM, Bridwell KH, Lenke LG, Kim YJ. Association between surgeon experience and complication rates in adult scoliosis surgery: a review of 5117 cases from the Scoliosis Research Society database 2004-2007. Spine (Phila Pa 1976). 2015;40:1200–1205. DOI: 10.1097/BRS.0000000000000993
21. Winter RB, Lonstein JE, Denis F, Leonard AS, Garamella JJ. Paraplegia resulting from vessel ligation. Spine (Phila Pa 1976). 1996;21:1232–1234. DOI: 10.1097/00007632-199605150-00017
22. Orchowsky J, Bridwell K, Lenke L. Neurological deficit from a purely vascular etiology after unilateral vessel ligation during anterior thoracolumbar fusion of the spine. Spine (Phila Pa 1976). 2005;30:406–410. DOI: 10.1097/01.brs.0000153391.55608.72
23. Myers MA, Hamilton SR, Bogosian AJ, Smith CH, Wagner TA. Visual loss as a complication of spine surgery. A review of 37 cases. Spine (Phila Pa 1976). 1997;22:1325–1329. DOI: 10.1097/00007632-199706150-00009
24. Mooney JF 3rd, Bernstein R, Hennrikus WL Jr, MacEwen GD. Neurologic risk management in scoliosis surgery. J Pediatr Orthop. 2002;22:683–689.
25. Cooper DE, Jenkins RS, Bready L, Rockwood CA Jr. The prevention of injuries of the brachial plexus secondary to malposition of the patient during surgery. Clin Orthop Relat Res. 1988;(228):33–41.
26. Prielipp RC, Morell RC, Walker FO, Santos CC, Bennett J, Butterworth J. Ulnar nerve pressure: influence of arm position and relationship to somatosensory evoked potentials. Anesthesiology. 1999;91:345–354. DOI: 10.1097/00000542-199908000-00006
27. Schwartz DM, Drummond DS, Hahn M, Ecker ML, Dormans JP. Prevention of positional brachial plexopathy during surgical correction of scoliosis. J Spinal Disord. 2000;13:178–182. DOI: 10.1097/00002517-200004000-00015
28. Mirovsky Y, Neuwirth M. Injuries to the lateral femoral cutaneous nerve during spine surgery. Spine (Phila Pa 1976). 2000;25:1266–1269. DOI: 10.1097/00007632-200005150-00011
29. Letts RM, Hollenberg C. Delayed paresis following spinal fusion with Harrington instrumentation. Clin Orthop Relat Res. 1977;(125):45–48.
30. Johnston CE 2nd, Happel LT Jr, Norris R, Burke SW, King AG, Roberts JM. Delayed paraplegia complicating sublaminar segmental spinal instrumentation. J Bone Joint Surg Am. 1986;68:556–563.
31. Diaz JH, Lockhart CH. Postoperative quadriplegia after spinal fusion for scoliosis with intraoperative awakening. Anesth Analg. 1987;66:1039–1042.
32. Mineiro J, Weinstein SL. Delayed postoperative paraparesis in scoliosis surgery. A case report. Spine (Phila Pa 1976). 1997;22:1668–1672. DOI: 10.1097/00007632-199707150-00027
33. Chang JH, Hoernschemeyer D, Sponseller P. Delayed postoperative paralysis in adolescent idiopathic scoliosis. Management with partial removal of hardware and staged correction. J Spinal Disord Tech. 2006;19:222–225. DOI: 10.1097/01.bsd.0000168323.58576.2f
34. Dapunt UA, Mok JM, Sharkey MS, Davis AA, Foster-Barber A, Diab M. Delayed presentation of tetraparesis following posterior thoracolumbar spinal fusion and instrumentation for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2009;34:E936–E941. DOI: 10.1097/BRS.0b013e3181b2e04f
35. Rittmeister M, Leyendecker K, Kurth A, Schmitt E. Cauda equina compression due to a laminar hook: A late complication of posterior instrumentation in scoliosis surgery. Eur Spine J. 1999;8:417–420. DOI: 10.1007/s005860050197
36. Ferrando A, Bas P, Bas T. Late neurological complications due to laminar hook compression in idiopathic scoliosis surgery. Spinal Cord Ser Cases. 2017;3:17081. DOI: 10.1038/s41394-017-0009-8
37. Suggala S, Dyess GA, Darbin O, Menger RP. Delayed neurological deficit due to a medially misplaced thoracic pedicle screw during adolescent idiopathic scoliosis correction: a complication 6 years in the making. Spine Deform. 2025;13:311–324. DOI: 10.1007/s43390-024-00951-7
38. Auerbach JD, Kean K, Milby AH, Paonessa KJ, Dormans JP, Newton PO, Song KM, Lonner BS. Delayed postoperative neurologic deficits in spinal deformity surgery. Spine (Phila Pa 1976). 2016;41:E131–E138. DOI: 10.1097/BRS.0000000000001194
39. Qiao J, Xiao L, Zhu Z, Xu L, Qian B, Liu Z, Sun X, Qiu Y. Delayed postoperative neurological deficit after spine deformity surgery: analysis of 5377 cases at 1 institution. World Neurosurg. 2018;111:e160–e164. DOI: 10.1016/jwneu.2017.12.010
40. Eismont FJ, Simeone FA. Bone overgrowth (hypertrophy) as a cause of late paraparesis after scoliosis fusion. A case report. J Bone Joint Surg Am. 1981;63:1016–1019.
41. Court-Brown CM, McMaster M. Pseudarthrosis: a late cause of paraparesis after scoliosis surgery. A case report. J Bone Joint Surg. 1982;64:1246–1248.
42. Roy DR, Huntington CF, MacEven GD. Pseudarthrosis resulting in complete paraplegia fifteen years after spinal fusion. Arch Orthop Trauma Surg (1978). 1984;102:213–215. DOI: 10.1007/BF00436131
43. Krodel A, Rehmet JC, Hamburger C. Spinal cord compression caused by the rod of a Harrington instrumentation device: a late complication in scoliosis surgery. Eur Spine J. 1997;6:208–210. DOI: 10.1007/BF01301439
44. Takahashi S, Delecrin J, Passuti N. Intraspinal metallosis causing delayed neurologic symptoms after spinal instrumentation surgery. Spine (Phila Pa 1976). 2001;26:1495–1499. DOI: 10.1097/00007632-200107010-00024
45. Beguiristain J, del Rio J, Duart J, Barroso J, Silva A, Villas C. Corrosion and late infection causing delayed paraparesis after spinal instrumentation. J Pediatr Orthop B. 2006;15:320–323. DOI: 10.1097/01202412-200609000-00003
46. Vialle R, Wolff S, David P, Lepeintre JF, Hautefort P, Tadie M. Late paraplegia after scoliosis treatment: an uncommon diagnosis. J Spinal Disord Tech. 2005;18:531–534. DOI: 10.1097/01.bsd.0000132285.19961.30
47. Gardner A. Paraparesis caused by a cyst in the spinal canal from a pseudarthrosis 22 years following Harrington rod procedure for scoliosis: a case report. J Med Case Reports. 2012;6:337. DOI: 10.1186/1752-1947-6-337
Review
For citations:
Mikhaylovskiy M.V., Buzunov A.V., Simonovich A.E. Neurological complications in scoliosis surgery: A systematic review of the problem. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2026;23(1):6-15. https://doi.org/10.14531/ss2026.1.6-15
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