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 - Funding Information:
Funds from the Scoliosis Research Society and AOSpine International, both non-profit organizations, and from Norton Healthcare, Louisville, KY, USA, were received in support of this work.
Publisher Copyright:
© 2018 The Authors
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 - Adult spinal deformity
KW - American Spinal Injury Association (ASIA) neurologic exam
KW - Lower extremity motor score (LEMS)
KW - Multicenter study
KW - Multivariate analysis
KW - Neurologic complications
KW - Predictor
KW - Risk factor
KW - Spinal deformity surgery
KW - Spinal osteotomy
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U2 - 10.1016/j.spinee.2018.02.001
DO - 10.1016/j.spinee.2018.02.001
M3 - Article
C2 - 29452281
AN - SCOPUS:85045261398
SN - 1529-9430
VL - 18
SP - 1733
EP - 1740
JO - Spine Journal
JF - Spine Journal
IS - 10
ER -