Aphasia after Spinal Deformity Correction Surgery in Adolescent Idiopathic Scoliosis A Case Report
Abstract
Introduction. Advancement in operative techniques, better understanding of biomechanics and breakthrough in technology making spinal deformity correction surgery become more feasible and conducted more often. Majority of the neurological complications were related to spinal cord disruption due to technical issues. However, neurological complications that were attributed to a brain pathology, were more likely to be of ischemic origin.
Case Illustration. We performed spinal deformity correction surgery on a 20-year old man with adult idiopathic scoliosis classification Lenke 2AN, with Cobb angle of 68°. On the second day, the serum sodium level showed a reduction. MRI examination revealed hyper acute infarct lesion on the posterior lobe of left temporo-parietal aspect. However, DSA examination was unremarkable. On the third postoperative day, his motoric and sensory functions, and sodium level returned to normal state. His cognitive function and communication abilities were able to return to normal gradually.
Discussion. Stroke that occurs during spinal deformity correction surgery is reported in 5.8% of operative cases. Prone positioning accompanied by extension of the neck can compress vertebral arteries, causing reduction in vascular flow. Therefore, inappropriate prone positioning on the operating table for a prolonged period may cause cerebral ischemia.
Conclusion. This case may serve as a reminder to surgeons and anesthesiologists towards the existence of such complications. Full awareness of the risk, good preoperative assessment, good surgical training, good communication, good teamwork, and good intraoperative and postoperative monitoring will minimize the risk for neurological complications.
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Bhagat S, Vozar V, Lutchman L, Crawford RJ, Rai AS. Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2013;22 Suppl 1:S42-6.
Yadla S, Maltenfort MG, Ratliff JK, Harrop JS. Adult scoliosis surgery outcomes: a systematic review. Neurosurgical focus. 2010;28(3):E3.
Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D, Study Group on S. Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. Spine. 2012;37(8):693-700.
Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW, Jr., et al. Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine. 2011;36(9):E593-7.
Tsai MC, Chou SY, Tsai CS, Hung TH, Su JA. Comparison of consecutive periods of 1-, 2-, and 3-year mortality of geriatric inpatients with delirium, dementia, and depression in a consultation-liaison service. International journal of psychiatry in medicine. 2013;45(1):45-57.
Neufeld KJ, Leoutsakos JM, Sieber FE, Wanamaker BL, Gibson Chambers JJ, Rao V, et al. Outcomes of early delirium diagnosis after general anesthesia in the elderly. Anesthesia and analgesia. 2013;117(2):471-8.
Davis DH, Muniz Terrera G, Keage H, Rahkonen T, Oinas M, Matthews FE, et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain : a journal of neurology. 2012;135(Pt 9):2809-16.
Selim M. Perioperative stroke. The New England journal of medicine. 2007;356(7):706-13.
Bateman BT, Schumacher HC, Wang S, Shaefi S, Berman MF. Perioperative acute ischemic stroke in noncardiac and nonvascular surgery: incidence, risk factors, and outcomes. Anesthesiology. 2009;110(2):231-8.
Bucerius J, Gummert JF, Borger MA, Walther T, Doll N, Onnasch JF, et al. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. The Annals of thoracic surgery. 2003;75(2):472-8.
Mashour GA, Woodrum DT, Avidan MS. Neurological complications of surgery and anaesthesia. British journal of anaesthesia. 2015;114(2):194-203.
Mashour GA, Sharifpour M, Freundlich RE, Tremper KK, Shanks A, Nallamothu BK, et al. Perioperative metoprolol and risk of stroke after noncardiac surgery. Anesthesiology. 2013;119(6):1340-6.
Ashes C, Judelman S, Wijeysundera DN, Tait G, Mazer CD, Hare GM, et al. Selective beta1-antagonism with bisoprolol is associated with fewer postoperative strokes than atenolol or metoprolol: a single-center cohort study of 44,092 consecutive patients. Anesthesiology. 2013;119(4):777-87.
Conrad MF, Ye JY, Chung TK, Davison JK, Cambria RP. Spinal cord complications after thoracic aortic surgery: long-term survival and functional status varies with deficit severity. Journal of vascular surgery. 2008;48(1):47-53.
Coselli JS, LeMaire SA, Koksoy C, Schmittling ZC, Curling PE. Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. Journal of vascular surgery. 2002;35(4):631-9.
Shen Y, Drum M, Roth S. The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesthesia and analgesia. 2009;109(5):1534-45.
Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, et al. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006;105(4):652-9; quiz 867-8.
Group GTC, Lewis SC, Warlow CP, Bodenham AR, Colam B, Rothwell PM, et al. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet. 2008;372(9656):2132-42.
Ng JL, Chan MT, Gelb AW. Perioperative stroke in noncardiac, nonneurosurgical surgery. Anesthesiology. 2011;115(4):879-90.
Bridwell KH, Lenke LG, Baldus C, Blanke K. Major intraoperative neurologic deficits in pediatric and adult spinal deformity patients. Incidence and etiology at one institution. Spine. 1998;23(3):324-31.
Garreau de Loubresse C. Neurological risks in scheduled spinal surgery. Orthopaedics & traumatology, surgery & research : OTSR. 2014;100(1 Suppl):S85-90.
Khalatbari MR, Khalatbari I, Moharamzad Y. Intracranial hemorrhage following lumbar spine surgery. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2012;21(10):2091-6.
Parikh S, Cohen JR. Perioperative stroke after general surgical procedures. New York state journal of medicine. 1993;93(3):162-5.
Marquez-Lara A, Nandyala SV, Fineberg SJ, Singh K. Cerebral vascular accidents after lumbar spine fusion. Spine. 2014;39(8):673-7.
Huang LC, Chung WF, Liu SW, Chang PY, Chen LF, Wu JC, et al. Lower Risk of Stroke after Deformity Surgery: Long Term Benefit Demonstrated by a National Cohort Study. International journal of environmental research and public health. 2015;12(10):12618-27.
Callewart CC, Minchew JT, Kanim LE, Tsai YC, Salehmoghaddam S, Dawson EG, et al. Hyponatremia and syndrome of inappropriate antidiuretic hormone secretion in adult spinal surgery. Spine. 1994;19(15):1674-9.
Shapiro G, Green DW, Fatica NS, Boachie-Adjei O. Medical complications in scoliosis surgery. Current opinion in pediatrics. 2001;13(1):36-41.
Mooney JF, 3rd, Bernstein R, Hennrikus WL, Jr., MacEwen GD. Neurologic risk management in scoliosis surgery. Journal of pediatric orthopedics. 2002;22(5):683-9.
Harman F, Yayci F, Deren S, Hasturk AE, Tarhan B, Yaman M, et al. Acute cerebellar ischemia after lumbar spinal surgery: a rare clinical entity. Journal of anesthesia. 2012;26(6):947-8.
Pamphlett R, Raisanen J, Kum-Jew S. Vertebral artery compression resulting from head movement: a possible cause of the sudden infant death syndrome. Pediatrics. 1999;103(2):460-8.
Kumar D, Hamid M, Kumar K. Another approach for prone positioning under general anaesthesia. Indian journal of anaesthesia. 2017;61(3):278-9.
Sala F, Palandri G, Basso E, Lanteri P, Deletis V, Faccioli F, et al. Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery. 2006;58(6):1129-43; discussion -43.
Nuwer MR, Dawson EG, Carlson LG, Kanim LE, Sherman JE. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalography and clinical neurophysiology. 1995;96(1):6-11.
Dawson EG, Sherman JE, Kanim LE, Nuwer MR. Spinal cord monitoring. Results of the Scoliosis Research Society and the European Spinal Deformity Society survey. Spine. 1991;16(8 Suppl):S361-4.
Fehlings MG, Brodke DS, Norvell DC, Dettori JR. The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference? Spine. 2010;35(9 Suppl):S37-46.
Owen JH. The application of intraoperative monitoring during surgery for spinal deformity. Spine. 1999;24(24):2649-62.
Kapoor K, Singh B, Dewan LI. Variations in the configuration of the circle of Willis. Anatomical science international. 2008;83(2):96-106.
Klimek-Piotrowska W, Rybicka M, Wojnarska A, Wojtowicz A, Koziej M, Holda MK. A multitude of variations in the configuration of the circle of Willis: an autopsy study. Anatomical science international. 2016;91(4):325-33.
Momjian-Mayor I, Baron JC. The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies. Stroke. 2005;36(3):567-77.
Ballotta E, Renon L, Da Giau G, Barbon B, De Rossi A, Baracchini C. Prospective randomized study on asymptomatic severe carotid stenosis and perioperative stroke risk in patients undergoing major vascular surgery: prophylactic or deferred carotid endarterectomy? Annals of vascular surgery. 2005;19(6):876-81.
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