Scoliosis: Neurologic Complications
Spinal Cord Spinal cord injury is the most feared complication of spinal surgery. Even when the spinal cord is not exposed, it is at risk for injury during reduction of deformities and during ligation of segmental vessels, which could precipitate an ischemic spinal cord event. Decreased blood flow in the anterior spinal artery can result in infarction of a significant portion of the spinal cord. Disruption of blood flow in the artery of Adamkiewicz often has been implicated in this phenomenon. Cadaveric investigations suggests that the anterior spinal artery typically appears to be a continuous structure. However, because of the wide range in luminal size there may be functional discontinuities in anterior spinal artery blood flow. Because of the changes in diameter (0.23 to 0.94 mm), variability in resistance to flow is likely. This resistance to flow may be as high as 278 times normal in vessels with narrow lumens, resulting in regions of functional hypoperfusion of the spinal cord. ...