Researchers in this study retrospectively analyzed pediatric patients
who received distraction-based growing implants to treat early-onset
scoliosis and identified the mechanism of injury for 4 patients with an
intraoperative brachial plexus injury.
“Patients with Sprengel deformity appear to be at increased risk for
brachial plexus injury when undergoing distraction-based spine
instrumentation with rib anchors. Injury to the brachial plexus can
occur with scapular elevation alone, presumably by direct compression of
the superior end of the scapula on the brachial plexus,” Elizabeth R.A. Joiner, BS,
and colleagues wrote in the study abstract. “Brachial plexus injuries
may be ‘hidden’ during monitoring of an arm in shoulder abduction but
symptomatic with shoulder adduction, as the brachial plexus is draped
over the elevated first rib.”
Joiner and colleagues performed a single-center review of 41 pediatric patients who underwent scoliosis correction surgery with distraction-based growing implants with rib anchors between 2001 and 2011.
They found three mechanisms of injury associated with brachial plexus
injuries that occurred 4 patients, which were “injury of the brachial
plexus by the first rib being pushed superiorly by rib-anchored growing
instrumentation, direct injury to the brachial plexus by the superior
pole of the retracted scapula, and injury of the brachial plexus when
the scapula was moved inferiorly during Sprengel deformity
reconstruction,” according to the abstract. The last two mechanisms of
injury were independent of spinal instrumentation, the researchers
noted.
Two patients with a brachial plexus injury had neurological symptoms or neuromonitoring signal changes with their arm in an adducted position, but not when it was abducted, and all the patients recovered completely, according to the abstract.
Disclosure: One of the authors (Skaggs) received a consulting fee or honorarium from Biomet, Medtronic and BeachBody LLC.
Source : Healio , 21st Nov 2013
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