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Researchers identify mechanism of brachial plexus injury in scoliosis surgery
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.