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

Michael G. Fehlings, So Kato, Lawrence G. Lenke, Hiroaki Nakashima, Narihito Nagoshi, 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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalSpine Journal
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Nervous System
Osteotomy
Incidence
Odds Ratio
Confidence Intervals
Lower Extremity
Cohort Studies
Multicenter Studies
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)

Keywords

  • Adult spinal deformity
  • American Spinal Injury Association (ASIA) neurologic exam
  • Lower extremity motor score (LEMS)
  • Multicenter study
  • Multivariate analysis
  • Neurologic complications
  • Predictor
  • Risk factor
  • Spinal deformity surgery
  • Spinal osteotomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery : results of the Scoli-RISK-1 study. / Fehlings, Michael G.; Kato, So; Lenke, Lawrence G.; Nakashima, Hiroaki; Nagoshi, Narihito; Shaffrey, Christopher I.; Cheung, Kenneth M.C.; Carreon, Leah; 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-Urquiza, Ferran; Lewis, Stephen J.; Berven, Sigurd H.

In: Spine Journal, 01.01.2018.

Research output: Contribution to journalArticle

Fehlings, MG, Kato, S, Lenke, LG, Nakashima, H, Nagoshi, N, 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 2018, 'Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study', Spine Journal. https://doi.org/10.1016/j.spinee.2018.02.001
Fehlings, Michael G. ; Kato, So ; Lenke, Lawrence G. ; Nakashima, Hiroaki ; Nagoshi, Narihito ; Shaffrey, Christopher I. ; Cheung, Kenneth M.C. ; Carreon, Leah ; 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-Urquiza, Ferran ; Lewis, Stephen J. ; Berven, Sigurd H. / Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery : results of the Scoli-RISK-1 study. In: Spine Journal. 2018.
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abstract = "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.",
keywords = "Adult spinal deformity, American Spinal Injury Association (ASIA) neurologic exam, Lower extremity motor score (LEMS), Multicenter study, Multivariate analysis, Neurologic complications, Predictor, Risk factor, Spinal deformity surgery, Spinal osteotomy",
author = "Fehlings, {Michael G.} and So Kato and Lenke, {Lawrence G.} and Hiroaki Nakashima and Narihito Nagoshi 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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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.

PY - 2018/1/1

Y1 - 2018/1/1

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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