Spinal cord injury following operative shoulder intervention: A case report

Context

Cervical myelopathy is a spinal cord dysfunction that results from extrinsic compression of the spinal cord, its blood supply, or both. It is the most common cause of spinal cord dysfunction in patients greater than 55 years of age.

Findings: A

57-year-old male with right shoulder septic arthritis underwent surgical debridement of his right shoulder and sustained a spinal cord injury intraoperatively. The most likely etiology is damage to the cervical spinal cord during difficult intubation requiring multiple attempts in this patient with underlying asymptomatic severe cervical stenosis.

Conclusion

Although it is not feasible to perform imaging studies on all patients undergoing intubation for surgery, this patient''s outcome would suggest consideration of inclusion of additional pre-surgical screening examination techniques, such as testing for a positive Hoffman''s reflex, is appropriate to detect asymptomatic patients who may have underlying cervical stenosis.     

Pavlov's Ratio of the Cervical Spine in a Korean Population: A Comparative Study by Age in Patients with Minor Trauma without Neurologic Symptoms

BackgroudThere are many studies on the vertebral body-to-canal ratio, the so-called Pavlov''s ratio of the cervical spine. However, there are no studies on its relation with age to clarify each bony component''s contribution to the spinal canal formation and its size. The aim of this study was to investigate differences and changes in the vertebral body-to-canal ratio according to age in an asymptomatic population.MethodsThis is a cross-sectional study of 280 asymptomatic individuals. A total of 140 men and 140 women representing each decade of life from the first to the seventh were included in this study. The anteroposterior length of the vertebral body and canal from C3 to C6 was measured on sagittal radiographs to calculate the vertebral body-to-canal ratio.ResultsThe average Pavlov''s ratio was significantly larger (p < 0.001) in the first decade of life. The average Pavlov''s ratio of the individuals in the first decade of life was 1.09 between C3 and C6 (1.08 at C3, 1.07 at C4, 1.11 at C5, and 1.13 at C6; range, 0.78–1.51). There was no significant difference among the other decades of life.ConclusionsWe assessed the Pavlov''s ratio of the cervical spine in an asymptomatic population. It is our belief that the spinal canal size is the largest in the first decade of life, and the Pavlov''s ratio becomes almost fixed throughout life after maturity.     

Clinical assessment of obesity in persons with spinal cord injury: validity of waist circumference, body mass index, and anthropometric index

Objective

To study the relationship of waist circumference (WC) and bioelectrical impedance analysis (BIA) and degree of agreement between anthropometric index (AI) and BIA, using BIA as a reference or ‘gold standard’. The second objective is to study the relationship between body mass index (BMI) and BIA in subjects with spinal cord injury (SCI).

Study design

Comparative cross-sectional study.

Setting

Convenience sample at outpatient clinic of spinal cord center.

Outcome measures

Estimation of obesity was made in 23 men with motor complete paraplegia (>1 year post-injury). Bland and Altman statistics were used to define level of agreement between AI and BIA, Pearson''s r to describe correlation between WC and BIA and BMI and BIA.

Results

Good agreement between BIA and AI with a small systematic difference in fat mass (FM) (mean difference: −0.28%, Pearson''s r: 0.91) was found. The correlation between WC and the BIA (% FM) was very high (Pearson''s r: 0.83). The correlation between WC and BMI (% FM) was just over moderate (Pearson''s r: 0.51).

Conclusion

AI seems to be a valid proxy measure to estimate obesity in males living with SCI. Measurement of obesity in persons with SCI based on WC is promising. BMI showed not to be valid to estimate obesity in persons with SCI.     

Longitudinally extensive transverse myelitis as the sole presentation of neuro-Behçet's disease responding to infliximab

Context

Isolated involvement of the spinal cord is an uncommon presentation of neuro-Behçet''s disease (NBD) and it is associated with a poor prognosis for functional recovery.

Method

A case report of an 18-year-old Turkish man who presented with a progressive paraparesis and bladder dysfunction secondary to a longitudinally extensive transverse myelitis as the sole presentation of NBD.

Findings

Examination revealed a spastic paraparesis and a T7 sensory level. Magnetic resonance imaging revealed multiple enhancing lesions throughout the thoracic cord and cerebrospinal fluid showed intense neutrophilia. On further enquiry a family history of Behçet''s disease was elicited. The patient subsequently reported a history of recurrent oral ulceration and intermittent occular inflammation. A diagnosis of NBD was made and intravenous high-dose steroids commenced with poor response. In view of the poor prognosis for functional recovery associated with spinal NBD the patient was treated with infliximab, an anti-tumour necrosis factor-alpha monoclonal antibody, leading to excellent recovery of function.

Conclusion/clinical relevance

Early treatment with infliximab may facilitate a favourable functional recovery and should be considered in cases of NBD with spinal cord involvement.     

Vision Loss After Spinal Fusion for Scoliosis in a Child With Spinal Cord Injury

Background:

Vision loss after spinal surgery is a rare and devastating complication. Risk factors include patient age, operative time, estimated blood loss, and intraoperative fluid management. Children with spinal cord injury often develop scoliosis that requires surgical correction.

Study Design:

Case report.

Methods:

Clinical and radiographic review was conducted of a 15-year-old boy who developed severe scoliosis after sustaining a C5 level injury at age 4 years from a motor vehicle crash.

Findings:

The patient underwent a posterior spinal fusion from T2 to the pelvis, and good correction of the spinal deformity was attained. During the 8-hour procedure, blood loss was 4,000 mL (approximately 1.2 blood volumes) and 17,000 mL of fluids were administered. On postoperative day 5, it was determined that the patient had complete visual loss. Neuro-ophthalmology consultation confirmed the diagnosis of posterior ischemic optic neuropathy.

Conclusions:

A significant number of children with spinal cord injury develop scoliosis requiring surgical correction. These procedures are often lengthy, with the potential for extensive blood loss and fluid shifts, factors that may increase the likelihood of postoperative vision loss. Patients should be counseled about this complication, and the surgical and anesthesiology teams should take all measures to minimize its occurrence.     

Intractable Pruritus After Traumatic Spinal Cord Injury

Background:

This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm.

Method:

Case report.

Findings:

Anatomic distribution of the pruritus corresponded to the dermatomal distribution of her level of spinal cord injury and vertebral fusion. Symptoms were attributed to the spinal cord injury and possible cervical root injury. Pruritus was refractory to all treatments, including topical lidocaine, gabapentin, transcutaneous electrical nerve stimulation, intravenous Bier block, stellate ganglion block, and acupuncture.

Conclusions:

Further understanding of neuropathic pruritus is needed. Diagnostic workup of intractable pruritus should include advanced imaging to detect ongoing nerve root compression. If diagnostic studies suggest radiculopathy, epidural steroid injection should be considered. Because the autonomic nervous system may be involved in complex chronic pain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective.     

Statewide Investigation of Medically Attended Adverse Health Conditions of Persons With Spinal Cord Injury

Background/Objective:

To report over a 10-year period the statewide prevalence and incidence of medically attended adverse health conditions in people with new traumatic spinal cord injury (TSCI).

Design:

Retrospective cohort study.

Methods:

(a) Identified all new TSCI cases discharged alive from statewide acute care hospitals, 1996 to 2000, using ICD-9-CM methodology. (b) Followed cases from 1996 to 2005 to quantify medically attended health conditions documented during emergency department visits, acute care hospitalizations, and outpatient hospital visits. (c) Used the life table method to calculate the prevalence and incidence of health conditions. (d) Examined Cox proportional hazard ratio of mortality by gender controlling for age and TSCI severity.

Results:

Nine hundred eighty-eight residents (257 women, 731 men) with TSCI were alive 90 days after discharge from acute care hospitalization from 1996 to 2000. Nine hundred twenty-three (251 female, 672 male) (93.4%) residents had an observed medically attended adverse health condition in the 10-year follow-up period. The most prevalent classes of diseases and disorders were (a) muscle and connective tissue, (b) renal and urinary, (c) digestive, (d) circulatory, (e) respiratory, (f) endocrine/nutritional/metabolic, and (g) infectious. Incidence of new injury was 29.0% for males and 26.9% for females. During the follow-up period, 49 women (19%) and 104 men (14%) died.

Conclusions:

People with TSCI experience diverse adverse health conditions in the 10 years after initial injury. An interdisciplinary health care provider team approach to allocating resources and implementing countermeasures to prevent or limit occurrence of these conditions is vital to these patients'' continuum of care.     

Survival and Prognostic Analysis of Adjacent Segments after Spinal Fusion

Background

To examine the survival function and prognostic factors of the adjacent segments based on a second operation after thoracolumbar spinal fusion.

Methods

This retrospective study reviewed 3,188 patients (3,193 cases) who underwent a thoracolumbar spinal fusion at the author''s hospital. Survival analysis was performed on the event of a second operation due to adjacent segment degeneration. The prognostic factors, such as the cause of the disease, surgical procedure, age, gender and number of fusion segments, were examined. Sagittal alignment and the location of the adjacent segment were measured in the second operation cases, and their association with the types of degeneration was investigated.

Results

One hundred seven patients, 112 cases (3.5%), underwent a second operation due to adjacent segment degeneration. The survival function was 97% and 94% at 5 and 10 years after surgery, respectively, showing a 0.6% linear reduction per year. The significant prognostic factors were old age, degenerative disease, multiple-level fusion and male. Among the second operation cases, the locations of the adjacent segments were the thoracolumbar junctional area and lumbosacral area in 11.6% and 88.4% of cases, respectively. Sagittal alignment was negative or neutral, positive and strongly positive in 47.3%, 38.9%, and 15.7%, respectively. Regarding the type of degeneration, spondylolisthesis or kyphosis, retrolisthesis, and neutral balance in the sagittal view was noted in 13.4%, 36.6%, and 50% of cases, respectively. There was a significant difference according to the location of the adjacent segment (p = 0.000) and sagittal alignment (p = 0.041).

Conclusions

The survival function of the adjacent segments was 94% at 10 years, which had decreased linearly by 0.6% per a year. The likelihood of a second operation was high in those with old age, degenerative disease, multiple-level fusion and male. There was a tendency for the type of degeneration to be spondylolisthesis or kyphosis in cases of the thoracolumbar junctional area and strongly positive sagittal alignment, but retrolisthesis in cases of the lumbosacral area and neutral or positive sagittal alignment.     

Normal morphology, age-related changes and abnormal findings of the cervical spine. Part II: magnetic resonance imaging of over 1,200 asymptomatic subjects

Purpose

The aim of this study is to establish standard MRI values for the cervical spinal canal, dural tube, and spinal cord, to evaluate age-related changes in healthy subjects, and to assess the prevalence of abnormal findings in asymptomatic subjects.

Methods

The sagittal diameter of the spinal canal and the sagittal diameter and cross-sectional area of the dural tube and spinal cord were measured on MRIs of 1,211 healthy volunteers. These included at least 100 men and 100 women in each decade of life between the third (20s) and eighth (70s). Abnormal findings such as spinal cord compression and signal changes in the spinal cord were recorded.

Results

The sagittal diameter of the spinal canal was 11.2 ± 1.4 mm [mean ± standard deviation (SD)]/11.1 ± 1.4 mm (male/female) at the mid-C5 vertebral level, and 9.5 ± 1.8/9.6 ± 1.6 mm at the C5/6 disc level. The cross-sectional area of the spinal cord was 78.1 ± 9.4/74.4 ± 9.4 mm² at the mid-C5 level and 70.6 ± 11.7/68.9 ± 11.3 mm² at the C5/6 disc level. Both the sagittal diameter and the axial area of the dural tube and spinal cord tended to decrease with increasing age. This tendency was more marked at the level of the intervertebral discs than at the level of the vertebral bodies, especially at the C5/6 intervertebral disc level. The spinal cord occupation rate in the dural tube at the C5 vertebral body level averaged 58.3 ± 7.0%. Spinal cord compression was observed in 64 cases (5.3%) and a T2 high-signal change was observed in 28 cases (2.3%).

Conclusions

Using MRI data of 1,211 asymptomatic subjects, the standard values for the cervical spinal canal, dural tube, and spinal cord for healthy members of each sex and each decade of life and the age-related changes in these parameters were established. The relatively high prevalence of abnormal MRI findings of the cervical spine in asymptomatic individuals emphasizes the dangers of predicating operative decisions on diagnostic tests without precisely correlating these findings with clinical signs and symptoms.     

Electrophrenic pacing and decannulation for high-level spinal cord injury: a case series

Background

In 1997, guidelines were developed for the management of high-level ventilator-dependent patients with spinal cord injury who had little or no ventilator-free breathing ability (VFBA). This article describes the three categories of patients, the decannulation criteria, and the successful decannulation of four patients with no VFBA and electrophrenic/diaphragm pacing, using these criteria.

Method

Case series.

Conclusion

Lack of VFBA in patients with high-level spinal cord injury does not mandate tracheostomy or electrophrenic/diaphragm pacing.     

Flexion Model Simulating Spinal Cord Injury Without Radiographic Abnormality in Patients With Ossification of the Longitudinal Ligament: The Influence of Flexion Speed on the Cervical Spine

Background/Objective:

It is suspected that the speed of the motion of the spinal cord under static compression may be the cause of spinal cord injury (SCI). However, little is known about the relationship between the speed of the motion of the spinal cord and its stress distributions. The objective was to carry out a biomechanical study of SCI in patients with ossification of the longitudinal ligament without radiologic evidence of injury.

Methods:

A 3-dimensional finite element spinal cord model was established. After the application of static compression, the model underwent anterior flexion to simulate SCI in ossification of the longitudinal ligament patients without radiologic abnormality. Flexion of the spine was assumed to occur at 1 motor segment. Flexion angle was 5°, and flexion speeds were 0.5°/s, 5°/s, and 50°/s. Stress distributions inside of the spinal cord were evaluated.

Results:

Stresses on the spinal cord increased slightly after the application of 5° of flexion at a speed of 0.5°/s. Stresses became much higher at a speed of 5°/s and increased further at 50°s.

Conclusions:

The stress distribution of the spinal cord under static compression increased with faster flexion speed of the spinal cord. High-speed motion of the spinal cord under static compression may be one of the causes of SCI in the absence of radiologic abnormality.     

Cervical instability presenting as thoracic pain: case report and literature review

Study design

Case report.

Objective

To report a case of cervical instability from an os odontoideum that presented as posterior thoracic pain and to present a review of the literature.

Background

Thoracic posterior paraspinal spasms and pain are common chief complaints in individuals with spinal abnormalities.

Methods

A 19-year-old man presented with posterior thoracic pain for nearly 1 year following a college sports-related injury (lacrosse). Computed tomography and magnetic resonance imaging did not reveal any significant thoracic or lumbar spinal cord or nerve root pathology, but did reveal an incidental finding of an os odontoideum.

Results

Surgical stabilization of the atlantoaxial instability resulting from the os odontoideum resulted in complete resolution of the patient''s thoracic pain.

Conclusions

Thoracic back pain without a clear thoracic spine etiology warrants further workup to rule out the possibility of spinal instability.     

Systemic Administration of Rolipram Increases Medullary and Spinal cAMP and Activates a Latent Respiratory Motor Pathway After High Cervical Spinal Cord Injury

Background/Objective:

High cervical spinal cord hemisection interrupts descending respiratory drive from the rostral ventral respiratory group in the medulla to the ipsilateral phrenic motoneurons. Hemisection results in the paralysis of the ipsilateral hemidiaphragm. Chronic administration of rolipram, a specific phosphodiesterase-IV inhibitor, promotes synaptic plasticity and restores phrenic nerve function after a high cervical spinal cord lesion. Here, we test the hypothesis that an acute administration of rolipram will increase spinal and medullary levels of 3′,5′-cyclic adenosine monophosphate (cAMP) and induce phrenic nerve recovery after cervical (C2) spinal cord hemisection.

Methods:

Male Sprague-Dawley rats were subjected to left C2 hemisection surgery 1 week before experimentation. Bilateral phrenic nerve activity was recorded in anesthetized, vagotomized, and pancuronium paralyzed rats, and rolipram was intravenously applied (2 mg/kg).

Results:

Intravenous administration of rolipram increased phrenic nerve output in uninjured control and left C2 spinal cord–hemisected rats. In addition, rolipram restored respiratory-related activity to the left phrenic nerve made quiescent by the hemisection. In both uninjured and hemisected rats, rolipram significantly enhanced phrenic inspiratory burst amplitude and burst area compared with predrug values. Also, rolipram concomitantly increased spinal and medullary cAMP.

Conclusions:

These results suggest that a phosphodiesterase inhibitor capable of elevating cAMP levels can enhance phrenic nerve output and restore respiratory-related phrenic nerve function after high cervical spinal cord injury. Thus, targeting the cAMP signaling cascade can be a useful therapeutic approach in promoting synaptic efficacy and respiratory recovery after cervical spinal cord injury.     

Nontraumatic acute paraplegia associated with cervical disk herniation

Background:

Acute paraplegia is a true emergency. It is often the result of trauma but is rarely reported in association with cervical disk herniation in patients without antecedent injury.

Methods:

Case report.

Findings:

This 75-year-old man presented with acute paraplegia due to severe compression of the spinal cord by herniation of the C4-C5 cervical disk. He underwent emergency diskectomy and anterior fusion. Postoperatively, his neurologic functions improved gradually.

Conclusions:

Cervical disk herniation should be considered in the differential diagnosis of nontraumatic acute paraplegia. Pre-existing narrowed canal is an important predisposing factor and excessive neck movements are believed to be triggering factors. Immediate early decompressive surgery is recommended to avoid irreversible progression of neurologic deficit.     

Reevaluation of the Pavlov Ratio in Patients with Cervical Myelopathy

Background

This study was designed to reevaluate the effectiveness of the Pavlov ratio in patients with cervical myelopathy.

Methods

We studied 107 patients who underwent open door laminoplasty for the treatment of cervical myelopathy between the C3 to C7 levels. We determined the Pavlov ratio on preoperative and postoperative cervical spine lateral radiographs, the vertebral body-to-canal ratio on sagittal reconstruction CT scans, and the vertebral body-to-cerebrospinal fluid (CSF) column ratio on T2-weighted sagittal MR images from C3 to C6. The severity of myelopathy was determined using the JOA score on both preoperative and postoperative images. The recovery rate was also calculated. The Pavlov ratio in plain radiographs from patients with myelopathy was compared with the ratio of the vertebral body to the spinal canal on CT and MRI.

Results

The average Pavlov ratio between C3 and C6 ranged from 0.71 to 0.76. On CT scan, the average vertebral body-to-canal ratio between C3 and C6 ranged from 0.62 to 0.66. On MRI, the vertebral body-to-CSF column ratio between C3 and C6 ranged between 0.53 and 0.57. A positive correlation was noted between the Pavlov ratio and the vertebral body-to-canal ratio on sagittal-reconstruction CT (correlation coefficient = 0.497-0.627, p = 0.000) and between the Pavlov ratio and the vertebral body-to-CSF column ratio on MRI (correlation coefficient = 0.511-0.649, p = 0.000).

Conclusions

We demonstrated a good correlation between the Pavlov ratio and both the vertebral body-to-canal ratio on CT and the vertebral body-to-CSF column ratio on MRI. Therefore, the Pavlov ratio can be relied upon to predict narrowing of the cervical spinal canal in the sagittal plane.     

Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation by people with complete spinal cord injury: a pilot study

Objectives

The objective of the study was to evaluate the safety and tolerance of use of the ReWalk^™ exoskeleton ambulation system in people with spinal cord injury. Measures of functional ambulation were also assessed and correlated to neurological spinal cord level, age, and duration since injury.

Study design

Case series observational study.

Setting

A national spinal cord injury centre.

Methods

Six volunteer participants were recruited from the follow-up outpatient clinic. Safety was assessed with regard to falls, status of the skin, status of the spine and joints, blood pressure, pulse, and electrocardiography (ECG). Pain and fatigue were graded by the participants using a visual analogue scale pre- and post-training. Participants completed a 10-statement questionnaire regarding safety, comfort, and secondary medical effects. After being able to walk 100 m, timed up and go, distance walked in 6 minutes and 10-m timed walk were measured.

Results

There were no adverse safety events. Use of the system was generally well tolerated, with no increase in pain and a moderate level of fatigue after use. Individuals with lower level of spinal cord injury performed walking more efficiently.

Conclusion

Volunteer participants were able to ambulate with the ReWalk^™ for a distance of 100 m, with no adverse effects during the course of an average of 13–14 training sessions. The participants were generally positive regarding the use of the system.     

Application of a correlation between the lumbar Torg ratio and the area of the spinal canal to predict lumbar stenosis: a study of 420 postmortem subjects

Background

A cervical Torg ratio of 0.8 has been used as a screening tool to determine the presence of cervical spinal stenosis. However, there have been no studies done to define the Torg ratio in the lumbar spine for predicting lumbar spinal stenosis (LSS). Torg ratios have never been correlated with the actual calculated canal area as derived from anatomic specimens. The aim of this study was to provide an analysis of the utility of the lumbar Torg ratio for predicting LSS based on objective measurements of skeletal specimens.

Materials and methods

420 adult skeletal specimens from the Hamann Todd Collection in the Cleveland Museum of Natural History were selected. Digital calipers were used to measure the sagittal diameter (SCD), interpedicular distance, pedicle length, and vertebral body diameter. The canal area at each level was calculated using a geometric formula. A standard distribution curve for canal area and Torg ratio was created, and values that were that is less than the mean minus two standard deviations (SD) below the mean were considered stenotic. Regression analysis was performed to determine if the Torg ratio was correlated with canal area, and if a “below normal” Torg ratio was predictive of LSS.

Results

The Torg ratio for 2SD below the mean was defined as 0.43 at L1, 0.43 at L2, 0.41 at L3, 0.38 at L4, 0.37 at L5. Regression analysis revealed a significant association of the Torg ratio with canal area (p < 0.01). A Torg ratio that was less than the mean − 2SD predicted canal stenosis at L2, L3, L4, and L5 (p < 0.01). Using a Torg ratio of <0.5 predicted stenosis with a sensitivity of 86 % and specificity of 52 % at all lumbar levels.

Conclusions

Based on the results of our study, we have defined the lower limit of the normal Torg ratio at each level. A Torg ratio of <0.5 predicts LSS and could be a useful radiological tool for LSS screening.     

Scapular Stabilization in Patients With Spinal Cord Injury

Background:

Severe scapular instability can be a considerable problem for people with high-level cervical spinal cord injury. Scapular instability reduces the effectiveness of the already weakened shoulder flexors and abductors, thereby limiting hand-to-mouth and hand-to-head activities. The winged scapula may cause inferior pole skin breakdown, as well as neck and shoulder pain.

Objective:

To report the efficacy of a fusionless scapular stabilization procedure as a means to enhance function in a consecutive group of patients with high-level cervical spinal cord injury.

Methods:

Four people with spinal cord injury at C4–C5 (2 male, 2 female; mean age  =  17.3 years, range  =  14–20 years) underwent scapular stabilization via scapulothoracic fusion (N  =  2) or by tethering the scapula to the rib cage with Mersilene tape as a fusionless stabilization (N  =  2). One patient died of unrelated causes 18 months after surgery, and the remaining 3 were followed for 26, 39, and 41 months, respectively. Data collection included radiographic analysis, active range of motion measures, and functional assessment.

Results:

Active shoulder flexion and abduction remained unchanged in 2 patients, but functional scores improved with regard to feeding and grooming capability. All patients reported satisfaction with postoperative appearance, and 3 patients reported considerable reduction in shoulder pain after surgery. Radiographs demonstrated maintenance of stable scapular alignment in all patients at final follow up. Wound breakdown, requiring removal of instrumentation, occurred in 2 patients.

Conclusion:

Scapular stabilization with or without fusion is a viable option to improve appearance, pain, and upper extremity function in people with high-level tetraplegia and scapular instability.     

Changes in Level of the Conus after Corrective Surgery for Scoliosis: MRI-Based Preliminary Study in 31 Patients

Background

Detection of postoperative spinal cord level change can provide basic information about the spinal cord status, and electrophysiological studies regarding this point should be conducted in the future.

Methods

To determine the changes in the spinal cord level postoperatively and the possible associated factors, we prospectively studied 31 patients with scoliosis. All the patients underwent correction and posterior fusion using pedicle screws and rods between January 2008 and March 2009. The pre- and postoperative conus medullaris levels were determined by matching the axial magnetic resonance image to the sagittal scout image. The patients were divided according to the change in the postoperative conus medullaris level. The change group was defined as the patients who showed a change of more than one divided section in the vertebral column postoperatively, and the parameters of the change and non-change groups were compared.

Results

The mean pre- and postoperative Cobb''s angle of the coronal curve was 76.80° ± 17.19° and 33.23° ± 14.39°, respectively. Eleven of 31 patients showed a lower conus medullaris level postoperatively. There were no differences in the pre- and postoperative magnitude of the coronal curve, lordosis and kyphosis between the groups. However, the postoperative degrees of correction of the coronal curve and lumbar lordosis were higher in the change group. There were also differences in the disease entities between the groups. A higher percentage of patients with Duchene muscular dystrophy had a change in level compared to that of the patients with cerebral palsy (83.3% vs. 45.5%, respectively).

Conclusions

The conus medullaris level changed postoperatively in the patients with severe scoliosis. Overall, the postoperative degree of correction of the coronal curve was higher in the change group than that in the non-change group. The degrees of correction of the coronal curve and lumbar lordosis were related to the spinal cord level change after scoliosis correction.