Neurological Deficit From a Purely Vascular Etiology After Unilateral Vessel Ligation During Anterior Thoracolumbar Fusion of the Spine
Notice bibliographique
Résumé
In Brief Study Design. Comprehensive analysis of patient records who underwent anterior approach to the thoracolumbar spine at a single institution. Objectives. To report on neurologic deficit from a purely vascular injury to the spinal cord occurring after unilateral anterior thoracolumbar spinal surgery that did not involve additional correction or other etiologies. Summary of Background Data. The largest study in the literature regarding the risks of neurovascular deficit during anterior exposure of the thoracolumbar spine reports that there exists no risk with unilateral ligature of the segmental arteries. Methods. The records and operative notes of 265 consecutive patients were reviewed. All adult neurologically intact patients, average age 40.2 years (range 18–85 years) who have had surgery between 1985 and 2002 that involved anterior approach to the thoracic spine were included. Segmental arteries were ligated midbody, away from the foramen and the aorta. Seventy-two percent of the approaches were left-sided. An average of 5.1 unilateral segmental artery ligations were performed per procedure. Results. Two patients out of 265 had major neurologic deficit after anterior thoracolumbar approach. Both patients had staged procedures: posterior spinal fusion then anterior spinal fusion to the thoracolumbar spine. One deficit occurred immediately after surgery and the other occurred 24 hours after surgery. No additional corrective maneuvers were performed; neither patient was hypotensive, nor did they experience blood loss anemia and their postoperative computed tomography myelogram study was normal. Conclusion. Neurologic deficit after anterior exposure to the thoracolumbar spine occurred in 0.75% of patients in this study exclusively from unilateral left-sided ligation of the T10-T12 segmental vessels. Both patients had common risks of prior kyphosis correction, revision surgery and left-sided approach. Two out of 265 patients sustained neurologic deficit after anterior thoracolumbar unilateral segmental vessel ligation. These deficits were secondary to a purely vascular etiology, as all other reasonable potential etiologies were excluded. One deficit occurred shortly after surgery and the other deficit occurred 24 hours after surgery. Both patients had common risks which included revision status, prior staged kyphosis correcting surgery and left-sided approach to T10–T12.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».