Neurologic Outcomes of Complex Adult Spinal Deformity Surgery: Results of the Prospective, Multicenter Scoli-RISK-1 Study

Lawrence G Lenke; Michael G Fehlings; Christopher I Shaffrey; Kenneth M C Cheung; Leah Carreon; Mark B Dekutoski; Frank J Schwab; Oheneba Boachie-Adjei; Khaled M Kebaish; Christopher P Ames; Yong Qiu; Yukihiro Matsuyama; Benny T Dahl; Hossein Mehdian; Ferran Pellisé-Urquiza; Stephen J Lewis; Sigurd H Berven

doi:10.1097/BRS.0000000000001338

Neurologic Outcomes of Complex Adult Spinal Deformity Surgery: Results of the Prospective, Multicenter Scoli-RISK-1 Study

Lawrence G Lenke, Michael G Fehlings, Christopher I Shaffrey, Kenneth M C Cheung, Leah Carreon, Mark B Dekutoski, Frank J Schwab, Oheneba Boachie-Adjei, Khaled M Kebaish, Christopher P Ames, Yong Qiu, Yukihiro Matsuyama, Benny T Dahl, Hossein Mehdian, Ferran Pellisé-Urquiza, Stephen J Lewis, Sigurd H Berven

Department of Clinical Medicine

55 Citations (Scopus)

Abstract

STUDY DESIGN: Prospective, multicenter, international observational study.

OBJECTIVE: To evaluate motor neurologic outcomes in patients undergoing surgery for complex adult spinal deformity (ASD).

SUMMARY OF BACKGROUND DATA: The neurologic outcomes after surgical correction for ASD have been reported with significant variability and have not been measured as a primary endpoint in any prospective, multicenter, observational study.

METHODS: The primary outcome measure was the change in American Spinal Injury Association (ASIA) Lower Extremity Motor Scores (LEMS) obtained preoperatively, and at hospital discharge, 6 weeks and 6 months postoperatively.

RESULTS: A total of 273 patients with complex ASD underwent surgery at 15 sites worldwide. One patient was excluded for lack of preoperative LEMS. The remaining 272 patients were divided into two groups: normal preoperative LEMS (=50) (Preop NML, N = 204, 75%) and abnormal preoperative LEMS (<50) (Preop ABNML, N = 68, 25%). At hospital discharge, 22.18% of patients showed a decline in LEMS compared with 12.78% who showed an improvement. At 6 weeks, there was a significant change compared with discharge: 17.91% patients showed a decline in LEMS and 16.42% showed an improvement. At 6 months, 10.82% patients showed a decline in preoperative LEMS, 20.52% improvement, and 68.66% maintenance. This was a significant change compared with 6 weeks and at discharge.

CONCLUSION: Although complex ASD surgery can restore neurologic function in patients with a preoperative neurologic deficit, a significant portion of patients with ASD experienced postoperative decline in LEMS. Measures that can anticipate and reduce the risk of postoperative neurologic complications are warranted.

LEVEL OF EVIDENCE: 3.

Original language	English
Journal	Spine
Volume	41
Issue number	3
Pages (from-to)	204-212
Number of pages	9
ISSN	0362-2436
DOIs	https://doi.org/10.1097/BRS.0000000000001338
Publication status	Published - Feb 2016

Keywords

Adolescent
Adult
Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Internationality
Male
Middle Aged
Neurosurgical Procedures
Postoperative Complications
Prospective Studies
Scoliosis
Treatment Outcome
Young Adult
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

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10.1097/BRS.0000000000001338

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Lenke, L. G., Fehlings, M. G., Shaffrey, C. I., Cheung, K. M. C., Carreon, L., Dekutoski, M. B., Schwab, F. J., Boachie-Adjei, O., Kebaish, K. M., Ames, C. P., Qiu, Y., Matsuyama, Y., Dahl, B. T., Mehdian, H., Pellisé-Urquiza, F., Lewis, S. J., & Berven, S. H. (2016). Neurologic Outcomes of Complex Adult Spinal Deformity Surgery: Results of the Prospective, Multicenter Scoli-RISK-1 Study. Spine, 41(3), 204-212. https://doi.org/10.1097/BRS.0000000000001338

Lenke, LG, Fehlings, MG, Shaffrey, CI, Cheung, KMC, Carreon, L, Dekutoski, MB, Schwab, FJ, Boachie-Adjei, O, Kebaish, KM, Ames, CP, Qiu, Y, Matsuyama, Y, Dahl, BT, Mehdian, H, Pellisé-Urquiza, F, Lewis, SJ & Berven, SH 2016, 'Neurologic Outcomes of Complex Adult Spinal Deformity Surgery: Results of the Prospective, Multicenter Scoli-RISK-1 Study', Spine, vol. 41, no. 3, pp. 204-212. https://doi.org/10.1097/BRS.0000000000001338

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title = "Neurologic Outcomes of Complex Adult Spinal Deformity Surgery: Results of the Prospective, Multicenter Scoli-RISK-1 Study",

abstract = "STUDY DESIGN: Prospective, multicenter, international observational study.OBJECTIVE: To evaluate motor neurologic outcomes in patients undergoing surgery for complex adult spinal deformity (ASD).SUMMARY OF BACKGROUND DATA: The neurologic outcomes after surgical correction for ASD have been reported with significant variability and have not been measured as a primary endpoint in any prospective, multicenter, observational study.METHODS: The primary outcome measure was the change in American Spinal Injury Association (ASIA) Lower Extremity Motor Scores (LEMS) obtained preoperatively, and at hospital discharge, 6 weeks and 6 months postoperatively.RESULTS: A total of 273 patients with complex ASD underwent surgery at 15 sites worldwide. One patient was excluded for lack of preoperative LEMS. The remaining 272 patients were divided into two groups: normal preoperative LEMS (=50) (Preop NML, N = 204, 75%) and abnormal preoperative LEMS (<50) (Preop ABNML, N = 68, 25%). At hospital discharge, 22.18% of patients showed a decline in LEMS compared with 12.78% who showed an improvement. At 6 weeks, there was a significant change compared with discharge: 17.91% patients showed a decline in LEMS and 16.42% showed an improvement. At 6 months, 10.82% patients showed a decline in preoperative LEMS, 20.52% improvement, and 68.66% maintenance. This was a significant change compared with 6 weeks and at discharge.CONCLUSION: Although complex ASD surgery can restore neurologic function in patients with a preoperative neurologic deficit, a significant portion of patients with ASD experienced postoperative decline in LEMS. Measures that can anticipate and reduce the risk of postoperative neurologic complications are warranted.LEVEL OF EVIDENCE: 3.",

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author = "Lenke, {Lawrence G} and Fehlings, {Michael G} and Shaffrey, {Christopher I} and Cheung, {Kenneth M C} and Leah Carreon and Dekutoski, {Mark B} and Schwab, {Frank J} and Oheneba Boachie-Adjei and Kebaish, {Khaled M} and Ames, {Christopher P} and Yong Qiu and Yukihiro Matsuyama and Dahl, {Benny T} and Hossein Mehdian and Ferran Pellis{\'e}-Urquiza and Lewis, {Stephen J} and Berven, {Sigurd H}",

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language = "English",

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T1 - Neurologic Outcomes of Complex Adult Spinal Deformity Surgery

T2 - Results of the Prospective, Multicenter Scoli-RISK-1 Study

AU - Lenke, Lawrence G

AU - Fehlings, Michael G

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

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N2 - STUDY DESIGN: Prospective, multicenter, international observational study.OBJECTIVE: To evaluate motor neurologic outcomes in patients undergoing surgery for complex adult spinal deformity (ASD).SUMMARY OF BACKGROUND DATA: The neurologic outcomes after surgical correction for ASD have been reported with significant variability and have not been measured as a primary endpoint in any prospective, multicenter, observational study.METHODS: The primary outcome measure was the change in American Spinal Injury Association (ASIA) Lower Extremity Motor Scores (LEMS) obtained preoperatively, and at hospital discharge, 6 weeks and 6 months postoperatively.RESULTS: A total of 273 patients with complex ASD underwent surgery at 15 sites worldwide. One patient was excluded for lack of preoperative LEMS. The remaining 272 patients were divided into two groups: normal preoperative LEMS (=50) (Preop NML, N = 204, 75%) and abnormal preoperative LEMS (<50) (Preop ABNML, N = 68, 25%). At hospital discharge, 22.18% of patients showed a decline in LEMS compared with 12.78% who showed an improvement. At 6 weeks, there was a significant change compared with discharge: 17.91% patients showed a decline in LEMS and 16.42% showed an improvement. At 6 months, 10.82% patients showed a decline in preoperative LEMS, 20.52% improvement, and 68.66% maintenance. This was a significant change compared with 6 weeks and at discharge.CONCLUSION: Although complex ASD surgery can restore neurologic function in patients with a preoperative neurologic deficit, a significant portion of patients with ASD experienced postoperative decline in LEMS. Measures that can anticipate and reduce the risk of postoperative neurologic complications are warranted.LEVEL OF EVIDENCE: 3.

AB - STUDY DESIGN: Prospective, multicenter, international observational study.OBJECTIVE: To evaluate motor neurologic outcomes in patients undergoing surgery for complex adult spinal deformity (ASD).SUMMARY OF BACKGROUND DATA: The neurologic outcomes after surgical correction for ASD have been reported with significant variability and have not been measured as a primary endpoint in any prospective, multicenter, observational study.METHODS: The primary outcome measure was the change in American Spinal Injury Association (ASIA) Lower Extremity Motor Scores (LEMS) obtained preoperatively, and at hospital discharge, 6 weeks and 6 months postoperatively.RESULTS: A total of 273 patients with complex ASD underwent surgery at 15 sites worldwide. One patient was excluded for lack of preoperative LEMS. The remaining 272 patients were divided into two groups: normal preoperative LEMS (=50) (Preop NML, N = 204, 75%) and abnormal preoperative LEMS (<50) (Preop ABNML, N = 68, 25%). At hospital discharge, 22.18% of patients showed a decline in LEMS compared with 12.78% who showed an improvement. At 6 weeks, there was a significant change compared with discharge: 17.91% patients showed a decline in LEMS and 16.42% showed an improvement. At 6 months, 10.82% patients showed a decline in preoperative LEMS, 20.52% improvement, and 68.66% maintenance. This was a significant change compared with 6 weeks and at discharge.CONCLUSION: Although complex ASD surgery can restore neurologic function in patients with a preoperative neurologic deficit, a significant portion of patients with ASD experienced postoperative decline in LEMS. Measures that can anticipate and reduce the risk of postoperative neurologic complications are warranted.LEVEL OF EVIDENCE: 3.

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KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Female

KW - Humans

KW - Internationality

KW - Male

KW - Middle Aged

KW - Neurosurgical Procedures

KW - Postoperative Complications

KW - Prospective Studies

KW - Scoliosis

KW - Treatment Outcome

KW - Young Adult

KW - Journal Article

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KW - Observational Study

KW - Research Support, Non-U.S. Gov't

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DO - 10.1097/BRS.0000000000001338

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JO - Spine

JF - Spine

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ER -

Neurologic Outcomes of Complex Adult Spinal Deformity Surgery: Results of the Prospective, Multicenter Scoli-RISK-1 Study

Abstract

Keywords

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