# Spinal cord injury in high-risk complex adult spinal deformity surgery: review of incidence and outcomes from the Scoli-RISK-1 study

## TL;DR

This study reviews six cases of spinal cord injury in high-risk adult spinal surgery, highlighting causes and outcomes.

## Contribution

The paper provides a detailed analysis of SCI cases from the Scoli-RISK-1 study, emphasizing management and outcomes.

## Key findings

- Six cases of SCI occurred in 272 surgeries (2.2%), with two intraoperative and four postoperative injuries.
- Postoperative incomplete SCI cases were managed with revision decompression and showed good recovery.
- One case had persistent deficits due to delayed treatment, underscoring the need for timely care.

## Abstract

Clinical case series.

To describe the cause, treatment and outcome of 6 cases of perioperative spinal cord injury (SCI) in high-risk adult deformity surgery.

Adult spinal deformity patients were enrolled in the multi-center Scoli-RISK-1 cohort study.

A total of 272 patients who underwent complex adult deformity surgery were enrolled in the prospective, multi-center Scoli-RISK-1 cohort study. Clinical follow up data were available up to a maximum of 2 years after index surgery. Cases of perioperative SCI were identified and an extensive case review was performed.

Six individuals with SCI were identified from the Scoli-RISK-1 database (2.2%). Two cases occurred intraoperatively and four cases occurred postoperatively. The first case was an incomplete SCI due to a direct intraoperative insult and was treated postoperatively with Riluzole. The second SCI case was caused by a compression injury due to overcorrection of the deformity. Three cases of incomplete SCI occurred; one case of postoperative hematoma, one case of proximal junctional kyphosis (PJK) and one case of adjacent segment disc herniation. All cases of post-operative incomplete SCI were managed with revision decompression and resulted in excellent clinical recovery. One case of incomplete SCI resulted from infection and PJK. The patient’s treatment was complicated by a delay in revision and the patient suffered persistent neurological deficits up to six weeks following the onset of SCI.

Despite the low incidence in high-risk adult deformity surgeries, perioperative SCI can result in devastating consequences. Thus, appropriate postoperative care, follow up and timely management of SCI are essential.