TY - JOUR
T1 - Unilateral versus bilateral lower extremity motor deficit following complex adult spinal deformity surgery
T2 - is there a difference in recovery up to 2-year follow-up?
AU - Tuchman, Alexander
AU - Lenke, Lawrence G.
AU - Cerpa, Meghan
AU - Fehlings, Michael G.
AU - Lewis, Stephen J.
AU - Shaffrey, Christopher I.
AU - Cheung, Kenneth M.C.
AU - Carreon, Leah Yacat
AU - Dekutoski, Mark B.
AU - Schwab, Frank J.
AU - Boachie-Adjei, Oheneba
AU - Kebaish, Khaled
AU - Ames, Christopher P.
AU - Qiu, Yong
AU - Matsuyama, Yukihiro
AU - Dahl, Benny T.
AU - Mehdian, Hossein
AU - Pellisé, Ferran
AU - Berven, Sigurd H.
N1 - Funding Information:
This study was supported organizationally and financially by the Scoliosis Research Society (SRS), Norton Healthcare, and AOSpine International. AOSpine is a clinical division of the AO Foundation—an independent medically guided nonprofit organization. We are grateful to AOSpine's Research department for study support and AO's Clinical Investigation and Documentation, especially Kathrin Espinoza for statistical assistance.
Funding Information:
This study was supported organizationally and financially by the Scoliosis Research Society (SRS), Norton Healthcare, and AOSpine International. AOSpine is a clinical division of the AO Foundation—an independent medically guided nonprofit organization. We are grateful to AOSpine's Research department for study support and AO's Clinical Investigation and Documentation, especially Kathrin Espinoza for statistical assistance. Author disclosures: AT: Nothing to disclose. LGL: Royalties: MEDTRONIC (I), Quality Medical Publishing (A); Consulting: Medtronic (paid consultant - monies donated to a charitable foundation), K2M (ended 2014) (paid consultant - monies donated to a charitable foundation), DePuy-Synthes Spine (ended 2014) (paid consultant - monies donated to a charitable foundation); Research Support - Staff and/or Materials: Setting Scoliosis Straight Foundation (A), EOS Imaging (A); Grants: Fox Family Foundation (A); Other: Broadwater (reimbursement for airfare/hotel), Seattle Science Foundation (reimbursement for airfare/hotel), Scoliosis Research Society (reimbursement for airfare/hotel; grant support - monies to institution), Stryker Spine (reimbursement for airfare/hotel), The Spinal Research Foundation (reimbursement for airfare/hotel), Fox Rothschild, LLC (Nonfinancial, expert witness in patent infringement case), AOSpine (reimbursement for airfare/hotel; grant support - monies to institution; fellowship support to institution). MC: Nothing to disclose. MGF: Nothing to disclose. SJL: Private Investments: Augmedics (5%), Neuraxia (4%), Covr medical (2%); Consulting: Medtronic (D, fellowship support), L&K (D), Stryker (C); Speaking and/or Teaching Arrangements: Stryker (D), L&K (B), Depuy Synthes (C); Trips/Travel: Stryker (B), AO (C), SRS (A), L&K (D), IMAST (B); Scientific Advisory Board: Augmedics (Nonfinancial, Member advisory board), Neuraxia (Nonfinancial, member advisory board); Fellowship Support: Medtronic and Johnson and Johnson (F, Paid directly to institution/employer). CIS: Royalties: Medtronic (F), Nuvasive (F), Zimmer Biomet (F); Stock Ownership: Nuvasive (34000 Shares); Consulting: K2M (B); Speaking and/or Teaching Arrangements: Stryker Spine (B); Board of Directors: AANS (Nonfinancial, Nonfunded position, travel expenses only), CSRS (Nonfinancial, Nonfunded position), ABNS (Nonfinancial, Nonfunded position, travel expenses only); Other Office: ABNS (Nonfinancial, Chair ABNS- Nonfunded position, travel expenses only); Grants: NIH (C), Department of Defense/ NACTN (F), ISSG (C); Fellowship Support: AO (E), NREF (E); Relationships Outside the One-Year Requirement: Depuy Synthes (07/2012, Consulting). KMCC: Board of Directors: Scoliosis Research Society (Nonfinancial, travel support to attend board meetings); Research Support - Staff and/or Materials: Research Grants Council (F, Paid directly to institution/employer). LYC: Device or Biologic Distributorship (Physician-Owned Distributorship): Pfizer (C, Support for Phase 2b FDA IDE Staphylococcus aureus 4-antigen vaccine, Paid directly to institution/employer), IntelliRod (B, Paid directly to institution/employer); Trips/Travel: Center for Spine Surgery and Research, Region of Southern Denmark (B, Travel and accommodations for Study Planning Meetings 05/2017, 08/2017, 12/2017); Scientific Advisory Board: University of Louisville Institutional Review Board (Nonfinancial, Member, University of Louisville Institutional Review Board), Scoliosis Research Society Research Committee (Nonfinancial, Member, Scoliosis Research Society Research Committee), The Spine Journal (Nonfinancial, Member, Editorial Advisory Board), Spine (Nonfinancial, Member, Editorial Advisory Board), Spine Deformity (Nonfinancial, Member, Editorial Advisory Board); Other Office: Norton Healthcare (Financial, Clinical Research Director - Salary), Center for Spine Surgery and Research, Lillebaelt Hospital, University of Southern Denmark (Professor); Research Support - Staff and/or Materials: Texas Scottish Rite Hospital / Scoliosis Research Society (B, Research grant Scoliosis-Specific Exercises for At-Risk Mild AIS Curves, Paid directly to institution/employer). MBD: Other Office: The CORE Institute (Nonfinancial, Quality Committee and Research Committee); Research Support - Staff and/or Materials: SPINENET (A, Paid directly to institution/employer); Grants: Mayo Foundation Office of IIntellectual Properties (D, Mayo Office IP/Medtronic Product Development Royalties Longitude I and II.Minority to Developer, No ongoing consulting, Paid directly to institution/employer). FJS: Royalties: MSD (D); Stock Ownership: nemaris, llc (37 Shares, 30%, medical imaging software); Consulting: MSD (B), Zimmer - Biomet (C), Globus (B); Speaking and/or Teaching Arrangements: Zimmer-Biomet (B); Board of Directors: Nemaris, INC (Nonfinancial, shares); Grants: DePuy Spine (H, Paid trough ISSG, Paid directly to institution/employer), Stryker (D, Paid trough ISSG, Paid directly to institution/employer), NuVasive (E, Paid trough ISSG, Paid directly to institution/employer), K2M (E, Paid trough ISSG, Paid directly to institution/employer). OBA: Royalties: K2M, Weigao (E, K2M Inc); Stock Ownership: K2M (E, company stock); Consulting: K2M and Weigao (D); Speaking and/or Teaching Arrangements: K2M and Weigao (B); Trips/Travel: K2M, Weigao (B); Scientific Advisory Board: K2M (C); Research Support - Staff and/or Materials: K2M (A); Fellowship Support: K2M (B). KK: Royalties: Depuy-Synthes (F); Consulting: SpineCraft (B); Speaking and/or Teaching Arrangements: K2M (B, Paid directly to institution/employer). CPA: Royalties: Biomet Zimmer Spine (C), Nuvasive (B), DePuy Synthes (F), Stryker (F), Next Orthosurgical (B), K2M (B), Medicrea (B); Consulting: Medtronic (B), DePuy (B), Stryker (B), Medicrea (B), K2M (C), Medicrea (B), Biomet Zimmer (B). YQ: Nothing to disclose. YM: Nothing to disclose. BTD: Fellowship Support: K2M (F, Paid directly to institution/employer); Other: Medtronic (F, Paid directly to institution/employer). HM: Nothing to disclose. FP: Consulting: DePuy Spine J&J (C), Zimmer-Biomet (B); Grants: DepuySpine Synthes (F, European Spine Study Group, Paid directly to institution/employer), Medtronic (C, Paid directly to institution/employer). SHB: Consulting: MEDTRONIC (C); Speaking and/or Teaching Arrangements: Medtronic (D), MISONIX, Inc. (B), Zimmer Biomet (B); Grants: MISONIX, Inc. (A); Fellowship Support: NuVasive (D, Fellowship Support, Paid directly to institution/employer), Globus (E, Fellowship Support, Paid directly to institution/employer), AOSpine (D, Fellowship Support).
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/3
Y1 - 2019/3
N2 - BACKGROUND CONTEXT: Scoli-RISK-1 is a multicenter prospective cohort designed to study neurologic outcomes following complex adult spinal deformity (ASD). The effect of unilateral versus bilateral postoperative motor deficits on the likelihood of long-term recovery has not been previously studied in this population. PURPOSE: To evaluate whether bilateral postoperative neurologic deficits have a worse recovery than unilateral deficits. STUDY DESIGN: Secondary analysis of a prospective, multicenter, international cohort study. METHODS: In a cohort of 272 patients, neurologic decline was defined as deterioration of the American Spinal Injury Association Lower Extremity Motor Scores (LEMS) following surgery. Patients with lower extremity neurologic decline were grouped into unilateral and bilateral cohorts. Differences in demographics, surgical variables, and patient outcome measures between the two cohorts were analyzed. RESULTS: A total of 265 patients had LEMS completed at discharge. Unilateral decline was seen in 32 patients (12%), while 29 (11%) had bilateral symptoms. At 2 years, there was no significant difference in either median LEMS (unilateral 50.0, interquartile range [IQR] 47.5–50.0; bilateral 50.0, IQR 48.0–50.0, p=.939) or change in LEMS from baseline (unilateral 0.0, IQR −1.0 to 0.0; bilateral 0.0, IQR −1.0 to 0.0, p=.920). In both groups, approximately two-thirds of patients saw recovery to at least their preoperative baseline by 2 years postoperatively (unilateral n=15, 63%; bilateral n=14, 67%). The mean Scoliosis Research Society-22R (SRS-22R) score at 2 years was 3.7±0.6 versus 3.2±0.6 (p=.009) for unilateral and bilateral groups, respectively. CONCLUSIONS: The prognosis for neurologic recovery of new motor deficits following complex adult spinal deformity is similar with both unilateral and bilateral weaknesses. Despite similar rates of neurologic recovery, patient reported outcomes for those with bilateral motor decline measured by SRS-22R are worse at 2 years after surgery.
AB - BACKGROUND CONTEXT: Scoli-RISK-1 is a multicenter prospective cohort designed to study neurologic outcomes following complex adult spinal deformity (ASD). The effect of unilateral versus bilateral postoperative motor deficits on the likelihood of long-term recovery has not been previously studied in this population. PURPOSE: To evaluate whether bilateral postoperative neurologic deficits have a worse recovery than unilateral deficits. STUDY DESIGN: Secondary analysis of a prospective, multicenter, international cohort study. METHODS: In a cohort of 272 patients, neurologic decline was defined as deterioration of the American Spinal Injury Association Lower Extremity Motor Scores (LEMS) following surgery. Patients with lower extremity neurologic decline were grouped into unilateral and bilateral cohorts. Differences in demographics, surgical variables, and patient outcome measures between the two cohorts were analyzed. RESULTS: A total of 265 patients had LEMS completed at discharge. Unilateral decline was seen in 32 patients (12%), while 29 (11%) had bilateral symptoms. At 2 years, there was no significant difference in either median LEMS (unilateral 50.0, interquartile range [IQR] 47.5–50.0; bilateral 50.0, IQR 48.0–50.0, p=.939) or change in LEMS from baseline (unilateral 0.0, IQR −1.0 to 0.0; bilateral 0.0, IQR −1.0 to 0.0, p=.920). In both groups, approximately two-thirds of patients saw recovery to at least their preoperative baseline by 2 years postoperatively (unilateral n=15, 63%; bilateral n=14, 67%). The mean Scoliosis Research Society-22R (SRS-22R) score at 2 years was 3.7±0.6 versus 3.2±0.6 (p=.009) for unilateral and bilateral groups, respectively. CONCLUSIONS: The prognosis for neurologic recovery of new motor deficits following complex adult spinal deformity is similar with both unilateral and bilateral weaknesses. Despite similar rates of neurologic recovery, patient reported outcomes for those with bilateral motor decline measured by SRS-22R are worse at 2 years after surgery.
KW - Complication
KW - Neurologic deficit
KW - Scoliosis
KW - Spinal deformity
KW - Spine
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85055901325&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055901325&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2018.08.003
DO - 10.1016/j.spinee.2018.08.003
M3 - Article
C2 - 30118851
AN - SCOPUS:85055901325
SN - 1529-9430
VL - 19
SP - 395
EP - 402
JO - Spine Journal
JF - Spine Journal
IS - 3
ER -