Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study
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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: The Spine Journal, Vol. 18, No. 10, 2018, p. 1733-1740.Research output: Contribution to journal › Journal article › Research › peer-review
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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
N1 - Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2018
Y1 - 2018
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 - Adolescent
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Cohort Studies
KW - Female
KW - Humans
KW - Incidence
KW - Lower Extremity/innervation
KW - Male
KW - Middle Aged
KW - Nervous System Diseases/epidemiology
KW - Neurologic Examination/methods
KW - Orthopedic Procedures/adverse effects
KW - Osteotomy/adverse effects
KW - Postoperative Complications/epidemiology
KW - Prospective Studies
KW - Risk Factors
KW - Spinal Diseases/surgery
KW - Spine/abnormalities
KW - Young Adult
U2 - 10.1016/j.spinee.2018.02.001
DO - 10.1016/j.spinee.2018.02.001
M3 - Journal article
C2 - 29452281
VL - 18
SP - 1733
EP - 1740
JO - Spine Journal
JF - Spine Journal
SN - 1529-9430
IS - 10
ER -
ID: 218612681