Perioperative neurologic injury associated with rib-based distraction surgery

Luke E. Gauthier, Yousef Mandourah, Alexandra Soroceanu, Amy L. McIntosh, John M. Flynn, Ron El-Hawary

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Study Design Retrospective, comparative case series from the study group database.

Objectives The primary objective was to report the neurologic injury rate for rib-based distraction surgery and determine whether preoperative diagnosis affects this rate. The secondary objective was to describe these injuries and outcome.

Summary of Background Data Posterior distraction-based systems are commonly used to treat early-onset scoliosis. General complication rates for these surgeries are high; however, there are few reports in the literature on neurologic injury after rib-based distraction surgery.

Methods This was a retrospective review of the Children's Spine Study Group database from 2004 to 2013. The researchers used the chi-square test to compare the distributions of proportions between diagnoses.

Results A total of 524 patients were identified and treated with rib-based distraction surgery. The preoperative diagnoses consisted of 222 congenital/structural, 163 neuromuscular, 63 syndromic, 67 idiopathic, and 9 unknown. There were 9 neurologic injuries (7 clinical and 2 neuromonitoring alerts) for a neurologic injury rate of 1.7%. Using the Classification for Early-Onset Scoliosis, 8 patients were classified as congenital and 1 as neuromuscular. The neurologic injury rate in the congenital curves group was 3.6% and was 0.34% in non-congenital curves (p =.005). The proportion of injured patients with an additional secondary diagnosis was 3.82%, compared with 0.82% patients with only a primary diagnosis (p =.01). Eight injuries occurred at initial implantation and 1 at revision surgery. Most were brachial plexus (n = 5) with no complete spinal cord injuries. Four patients required return to surgery and 1 needed intraoperative intervention. At 4.2 years' follow-up, 7 of 9 patients had full resolution of symptoms and 2 patients had residual upper extremity weakness.

Conclusions The rate of neurologic injury for patients treated with rib-based distraction surgery was 1.7%. Most injuries occurred with congenital diagnoses and they were more likely in patients with additional secondary diagnoses. These injuries were predominantly to the brachial plexus and generally resolved.

Original languageEnglish (US)
Pages (from-to)481-488
Number of pages8
JournalSpine deformity
Issue number6
StatePublished - Nov 1 2014


  • Early-onset scoliosis
  • Expandable
  • Neurologic complication
  • Prosthetic
  • Rib
  • Rib-based posterior distraction
  • Titanium
  • Vertical

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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