Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study

TY - JOUR

T1 - Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery

T2 - results of the Scoli-RISK-1 study

AU - Fehlings, Michael G

AU - Kato, So

AU - Lenke, Lawrence G

AU - Nakashima, Hiroaki

AU - Nagoshi, Narihito

AU - Shaffrey, Christopher I

AU - Cheung, Kenneth M C

AU - Carreon, Leah

AU - Dekutoski, Mark B

AU - Schwab, Frank J

AU - Boachie-Adjei, Oheneba

AU - Kebaish, Khaled M

AU - Ames, Christopher P

AU - Qiu, Yong

AU - Matsuyama, Yukihiro

AU - Dahl, Benny T

AU - Mehdian, Hossein

AU - Pellisé-Urquiza, Ferran

AU - Lewis, Stephen J

AU - Berven, Sigurd H

N1 - Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

PY - 2018/10

Y1 - 2018/10

N2 - BACKGROUND CONTEXT: Significant variability in neurologic outcomes after surgical correction for adult spinal deformity (ASD) has been reported. Risk factors for decline in neurologic motor outcomes are poorly understood.PURPOSE: The objective of the present investigation was to identify the risk factors for postoperative neurologic motor decline in patients undergoing complex ASD surgery.STUDY DESIGN/SETTING: This is a prospective international multicenter cohort study.PATIENT SAMPLE: From September 2011 to October 2012, 272 patients undergoing complex ASD surgery were prospectively enrolled in a multicenter, international cohort study in 15 sites.OUTCOME MEASURES: Neurologic decline was defined as any postoperative deterioration in American Spinal Injury Association lower extremity motor score (LEMS) compared with preoperative status.METHODS: To identify risk factors, 10 candidate variables were selected for univariable analysis from the dataset based on clinical relevance, and a multivariable logistic regression analysis was used with backward stepwise selection.RESULTS: Complete datasets on 265 patients were available for analysis and 61 (23%) patients showed a decline in LEMS at discharge. Univariable analysis showed that the key factors associated with postoperative neurologic deterioration included older age, lumbar-level osteotomy, three-column osteotomy, and larger blood loss. Multivariable analysis revealed that older age (odds ratio [OR]=1.5 per 10 years, 95% confidence interval [CI] 1.1-2.1, p=.005), larger coronal deformity angular ratio [DAR] (OR=1.1 per 1 unit, 95% CI 1.0-1.2, p=.037), and lumbar osteotomy (OR=3.3, 95% CI 1.2-9.2, p=.022) were the three major predictors of neurologic decline.CONCLUSIONS: Twenty-three percent of patients undergoing complex ASD surgery experienced a postoperative neurologic decline. Age, coronal DAR, and lumbar osteotomy were identified as the key contributing factors.

AB - BACKGROUND CONTEXT: Significant variability in neurologic outcomes after surgical correction for adult spinal deformity (ASD) has been reported. Risk factors for decline in neurologic motor outcomes are poorly understood.PURPOSE: The objective of the present investigation was to identify the risk factors for postoperative neurologic motor decline in patients undergoing complex ASD surgery.STUDY DESIGN/SETTING: This is a prospective international multicenter cohort study.PATIENT SAMPLE: From September 2011 to October 2012, 272 patients undergoing complex ASD surgery were prospectively enrolled in a multicenter, international cohort study in 15 sites.OUTCOME MEASURES: Neurologic decline was defined as any postoperative deterioration in American Spinal Injury Association lower extremity motor score (LEMS) compared with preoperative status.METHODS: To identify risk factors, 10 candidate variables were selected for univariable analysis from the dataset based on clinical relevance, and a multivariable logistic regression analysis was used with backward stepwise selection.RESULTS: Complete datasets on 265 patients were available for analysis and 61 (23%) patients showed a decline in LEMS at discharge. Univariable analysis showed that the key factors associated with postoperative neurologic deterioration included older age, lumbar-level osteotomy, three-column osteotomy, and larger blood loss. Multivariable analysis revealed that older age (odds ratio [OR]=1.5 per 10 years, 95% confidence interval [CI] 1.1-2.1, p=.005), larger coronal deformity angular ratio [DAR] (OR=1.1 per 1 unit, 95% CI 1.0-1.2, p=.037), and lumbar osteotomy (OR=3.3, 95% CI 1.2-9.2, p=.022) were the three major predictors of neurologic decline.CONCLUSIONS: Twenty-three percent of patients undergoing complex ASD surgery experienced a postoperative neurologic decline. Age, coronal DAR, and lumbar osteotomy were identified as the key contributing factors.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Female

KW - Humans

KW - Incidence

KW - Lower Extremity/innervation

KW - Male

KW - Middle Aged

KW - Nervous System Diseases/epidemiology

KW - Neurologic Examination/methods

KW - Orthopedic Procedures/adverse effects

KW - Osteotomy/adverse effects

KW - Postoperative Complications/epidemiology

KW - Prospective Studies

KW - Risk Factors

KW - Spinal Diseases/surgery

KW - Spine/abnormalities

KW - Young Adult

U2 - 10.1016/j.spinee.2018.02.001

DO - 10.1016/j.spinee.2018.02.001

M3 - Journal article

C2 - 29452281

SN - 1529-9430

VL - 18

SP - 1733

EP - 1740

JO - Spine Journal

JF - Spine Journal

IS - 10

ER -