An Analysis of the Incidence and Outcomes of Major Versus Minor Neurological Decline After Complex Adult Spinal Deformity Surgery: A Subanalysis of Scoli-RISK-1 Study

So Kato, Michael G. Fehlings, Stephen J. Lewis, Lawrence G. Lenke, Christopher I. Shaffrey, Kenneth M.C. Cheung, Leah Y. 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, Sigurd H. Berven

Research output: Contribution to journalArticle

Abstract

Study Design. A subanalysis from a prospective, multicenter, international cohort study in 15 sites (Scoli-RISK-1). Objective. To report detailed information regarding the severity of neurological decline related to complex adult spine deformity (ASD) surgery and to examine outcomes based on severity. Summary of Background Data. Postoperative neurological decline after ASD surgeries can occur due to nerve root(s) or spinal cord dysfunction. The impact of decline and the pattern of recovery may be related to the anatomic location and the severity of the injury. Methods. An investigation of 272 prospectively enrolled complex ASD surgical patients with neurological status measured by American Spinal Injury Association Lower Extremity Motor Scores (LEMS) was undertaken. Postoperative neurological decline was categorized into "major" (≥5 points loss) versus "minor" (<5 points loss) deficits. Timing and extent of recovery in LEMS were investigated for each group. Results. Among the 265 patients with LEMS available at discharge, 61 patients (23%) had neurological decline, with 20 (33%) experiencing major decline. Of note, 90% of the patients with major decline had deficits in three or more myotomes. Full recovery was seen in 24% at 6 weeks and increased to 65% at 6 months. However, 34% continued to experience some neurological decline at 24 months, with 6% demonstrating no improvement. Of 41 patients (67%) with minor decline, 73% had deficits in one or two myotomes. Full recovery was seen in 49% at 6 weeks and increased to 70% at 6 months. Of note, 26% had persistence of some neurological deficit at 24 months, with 18% demonstrating no recovery. Conclusion. In patients undergoing complex ASD correction, a rate of postoperative neurological decline of 23% was noted with 33% of these being "major." Although most patients showed substantial recovery by 6 months, approximately one-third continued to experience neurological dysfunction.

Original languageEnglish (US)
Pages (from-to)905-912
Number of pages8
JournalSpine
Volume43
Issue number13
DOIs
StatePublished - Jul 1 2018

Fingerprint

Incidence
Spine
Lower Extremity
Patient Discharge
Spinal Cord
Cohort Studies
Wounds and Injuries

Keywords

  • acute neurologic complications
  • adult spinal deformity
  • American Spinal Injury Association neurologic exam
  • incidence
  • lower extremity motor score
  • outcome
  • recovery
  • severity
  • spinal osteotomy
  • time course

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

An Analysis of the Incidence and Outcomes of Major Versus Minor Neurological Decline After Complex Adult Spinal Deformity Surgery : A Subanalysis of Scoli-RISK-1 Study. / Kato, So; Fehlings, Michael G.; Lewis, Stephen J.; Lenke, Lawrence G.; Shaffrey, Christopher I.; Cheung, Kenneth M.C.; Carreon, Leah Y.; Dekutoski, Mark B.; Schwab, Frank J.; Boachie-Adjei, Oheneba; Kebaish, Khaled M; Ames, Christopher P.; Qiu, Yong; Matsuyama, Yukihiro; Dahl, Benny T.; Mehdian, Hossein; Pellisé, Ferran; Berven, Sigurd H.

In: Spine, Vol. 43, No. 13, 01.07.2018, p. 905-912.

Research output: Contribution to journalArticle

Kato, S, Fehlings, MG, Lewis, SJ, Lenke, LG, Shaffrey, CI, Cheung, KMC, Carreon, LY, Dekutoski, MB, Schwab, FJ, Boachie-Adjei, O, Kebaish, KM, Ames, CP, Qiu, Y, Matsuyama, Y, Dahl, BT, Mehdian, H, Pellisé, F & Berven, SH 2018, 'An Analysis of the Incidence and Outcomes of Major Versus Minor Neurological Decline After Complex Adult Spinal Deformity Surgery: A Subanalysis of Scoli-RISK-1 Study', Spine, vol. 43, no. 13, pp. 905-912. https://doi.org/10.1097/BRS.0000000000002486
Kato, So ; Fehlings, Michael G. ; Lewis, Stephen J. ; Lenke, Lawrence G. ; Shaffrey, Christopher I. ; Cheung, Kenneth M.C. ; Carreon, Leah Y. ; Dekutoski, Mark B. ; Schwab, Frank J. ; Boachie-Adjei, Oheneba ; Kebaish, Khaled M ; Ames, Christopher P. ; Qiu, Yong ; Matsuyama, Yukihiro ; Dahl, Benny T. ; Mehdian, Hossein ; Pellisé, Ferran ; Berven, Sigurd H. / An Analysis of the Incidence and Outcomes of Major Versus Minor Neurological Decline After Complex Adult Spinal Deformity Surgery : A Subanalysis of Scoli-RISK-1 Study. In: Spine. 2018 ; Vol. 43, No. 13. pp. 905-912.
@article{835210d6a1c34cb3a6fa9c38f0447320,
title = "An Analysis of the Incidence and Outcomes of Major Versus Minor Neurological Decline After Complex Adult Spinal Deformity Surgery: A Subanalysis of Scoli-RISK-1 Study",
abstract = "Study Design. A subanalysis from a prospective, multicenter, international cohort study in 15 sites (Scoli-RISK-1). Objective. To report detailed information regarding the severity of neurological decline related to complex adult spine deformity (ASD) surgery and to examine outcomes based on severity. Summary of Background Data. Postoperative neurological decline after ASD surgeries can occur due to nerve root(s) or spinal cord dysfunction. The impact of decline and the pattern of recovery may be related to the anatomic location and the severity of the injury. Methods. An investigation of 272 prospectively enrolled complex ASD surgical patients with neurological status measured by American Spinal Injury Association Lower Extremity Motor Scores (LEMS) was undertaken. Postoperative neurological decline was categorized into {"}major{"} (≥5 points loss) versus {"}minor{"} (<5 points loss) deficits. Timing and extent of recovery in LEMS were investigated for each group. Results. Among the 265 patients with LEMS available at discharge, 61 patients (23{\%}) had neurological decline, with 20 (33{\%}) experiencing major decline. Of note, 90{\%} of the patients with major decline had deficits in three or more myotomes. Full recovery was seen in 24{\%} at 6 weeks and increased to 65{\%} at 6 months. However, 34{\%} continued to experience some neurological decline at 24 months, with 6{\%} demonstrating no improvement. Of 41 patients (67{\%}) with minor decline, 73{\%} had deficits in one or two myotomes. Full recovery was seen in 49{\%} at 6 weeks and increased to 70{\%} at 6 months. Of note, 26{\%} had persistence of some neurological deficit at 24 months, with 18{\%} demonstrating no recovery. Conclusion. In patients undergoing complex ASD correction, a rate of postoperative neurological decline of 23{\%} was noted with 33{\%} of these being {"}major.{"} Although most patients showed substantial recovery by 6 months, approximately one-third continued to experience neurological dysfunction.",
keywords = "acute neurologic complications, adult spinal deformity, American Spinal Injury Association neurologic exam, incidence, lower extremity motor score, outcome, recovery, severity, spinal osteotomy, time course",
author = "So Kato and Fehlings, {Michael G.} and Lewis, {Stephen J.} and Lenke, {Lawrence G.} and Shaffrey, {Christopher I.} and Cheung, {Kenneth M.C.} and Carreon, {Leah Y.} 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} and Berven, {Sigurd H.}",
year = "2018",
month = "7",
day = "1",
doi = "10.1097/BRS.0000000000002486",
language = "English (US)",
volume = "43",
pages = "905--912",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "13",

}

TY - JOUR

T1 - An Analysis of the Incidence and Outcomes of Major Versus Minor Neurological Decline After Complex Adult Spinal Deformity Surgery

T2 - A Subanalysis of Scoli-RISK-1 Study

AU - Kato, So

AU - Fehlings, Michael G.

AU - Lewis, Stephen J.

AU - Lenke, Lawrence G.

AU - Shaffrey, Christopher I.

AU - Cheung, Kenneth M.C.

AU - Carreon, Leah Y.

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, Ferran

AU - Berven, Sigurd H.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Study Design. A subanalysis from a prospective, multicenter, international cohort study in 15 sites (Scoli-RISK-1). Objective. To report detailed information regarding the severity of neurological decline related to complex adult spine deformity (ASD) surgery and to examine outcomes based on severity. Summary of Background Data. Postoperative neurological decline after ASD surgeries can occur due to nerve root(s) or spinal cord dysfunction. The impact of decline and the pattern of recovery may be related to the anatomic location and the severity of the injury. Methods. An investigation of 272 prospectively enrolled complex ASD surgical patients with neurological status measured by American Spinal Injury Association Lower Extremity Motor Scores (LEMS) was undertaken. Postoperative neurological decline was categorized into "major" (≥5 points loss) versus "minor" (<5 points loss) deficits. Timing and extent of recovery in LEMS were investigated for each group. Results. Among the 265 patients with LEMS available at discharge, 61 patients (23%) had neurological decline, with 20 (33%) experiencing major decline. Of note, 90% of the patients with major decline had deficits in three or more myotomes. Full recovery was seen in 24% at 6 weeks and increased to 65% at 6 months. However, 34% continued to experience some neurological decline at 24 months, with 6% demonstrating no improvement. Of 41 patients (67%) with minor decline, 73% had deficits in one or two myotomes. Full recovery was seen in 49% at 6 weeks and increased to 70% at 6 months. Of note, 26% had persistence of some neurological deficit at 24 months, with 18% demonstrating no recovery. Conclusion. In patients undergoing complex ASD correction, a rate of postoperative neurological decline of 23% was noted with 33% of these being "major." Although most patients showed substantial recovery by 6 months, approximately one-third continued to experience neurological dysfunction.

AB - Study Design. A subanalysis from a prospective, multicenter, international cohort study in 15 sites (Scoli-RISK-1). Objective. To report detailed information regarding the severity of neurological decline related to complex adult spine deformity (ASD) surgery and to examine outcomes based on severity. Summary of Background Data. Postoperative neurological decline after ASD surgeries can occur due to nerve root(s) or spinal cord dysfunction. The impact of decline and the pattern of recovery may be related to the anatomic location and the severity of the injury. Methods. An investigation of 272 prospectively enrolled complex ASD surgical patients with neurological status measured by American Spinal Injury Association Lower Extremity Motor Scores (LEMS) was undertaken. Postoperative neurological decline was categorized into "major" (≥5 points loss) versus "minor" (<5 points loss) deficits. Timing and extent of recovery in LEMS were investigated for each group. Results. Among the 265 patients with LEMS available at discharge, 61 patients (23%) had neurological decline, with 20 (33%) experiencing major decline. Of note, 90% of the patients with major decline had deficits in three or more myotomes. Full recovery was seen in 24% at 6 weeks and increased to 65% at 6 months. However, 34% continued to experience some neurological decline at 24 months, with 6% demonstrating no improvement. Of 41 patients (67%) with minor decline, 73% had deficits in one or two myotomes. Full recovery was seen in 49% at 6 weeks and increased to 70% at 6 months. Of note, 26% had persistence of some neurological deficit at 24 months, with 18% demonstrating no recovery. Conclusion. In patients undergoing complex ASD correction, a rate of postoperative neurological decline of 23% was noted with 33% of these being "major." Although most patients showed substantial recovery by 6 months, approximately one-third continued to experience neurological dysfunction.

KW - acute neurologic complications

KW - adult spinal deformity

KW - American Spinal Injury Association neurologic exam

KW - incidence

KW - lower extremity motor score

KW - outcome

KW - recovery

KW - severity

KW - spinal osteotomy

KW - time course

UR - http://www.scopus.com/inward/record.url?scp=85050184933&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050184933&partnerID=8YFLogxK

U2 - 10.1097/BRS.0000000000002486

DO - 10.1097/BRS.0000000000002486

M3 - Article

C2 - 29894429

AN - SCOPUS:85050184933

VL - 43

SP - 905

EP - 912

JO - Spine

JF - Spine

SN - 0362-2436

IS - 13

ER -