Michael G Fehlings1, So Kato2, Lawrence G Lenke3, Hiroaki Nakashima2, Narihito Nagoshi2, Christopher I Shaffrey4, Kenneth M C Cheung5, Leah Carreon6, Mark B Dekutoski7, Frank J Schwab8, Oheneba Boachie-Adjei9, Khaled M Kebaish10, Christopher P Ames11, Yong Qiu12, Yukihiro Matsuyama13, Benny T Dahl14, Hossein Mehdian15, Ferran Pellisé-Urquiza16, Stephen J Lewis2, Sigurd H Berven11. 1. University of Toronto and Toronto Western Hospital, 399 Bathurst St 4W-449, Toronto, Ontario, M5T 2S8, Canada. Electronic address: Michael.Fehlings@uhn.ca. 2. University of Toronto and Toronto Western Hospital, 399 Bathurst St 4W-449, Toronto, Ontario, M5T 2S8, Canada. 3. Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA. 4. University of Virginia, P.O. Box 800386, Charlottesville, VA 22908-0212, USA. 5. The University of Hong Kong, Professional Block, 5th Flr, 102 Pokfulam Road, Hong Kong, SAR, China. 6. Norton Leatherman Spine Center, 210 E. Gray St, Suite 900, Louisville, KY 40202, USA. 7. The CORE Institute, 14520 W Granite Valley Dr #210, Sun City West, AZ 85375, USA. 8. Hospital for Special Surgery, 535 East 70th St, Hospital for Special Surgery, New York, NY 10021, USA. 9. The FOCOS Hospital, 8 Teshie St, Patang, Accra, Ghana. 10. Johns Hopkins University, 601 N Caroline St, Baltimore, MD, 21287, USA. 11. University of California San Francisco, 400 Parnassus Ave, San Francisco, CA 94143, USA. 12. Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Rd, Gulou Qu, Nanjing Shi, Jiangsu Sheng, 210008, China. 13. Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi Ward, Hamamatsu, 431-3192 Shizuoka Prefecture, Japan. 14. Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Section 2162, Blegdamsvej 9, 2100 København Ø, Copenhagen, Denmark; Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA. 15. University Hospital, Queen's Medical Centre, Derby Rd, Nottingham NG7 2RD, UK. 16. Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
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.
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.
Authors: Rajiv R Iyer; Michael G Vitale; Adam N Fano; Hiroko Matsumoto; Daniel J Sucato; Amer F Samdani; Justin S Smith; Munish C Gupta; Michael P Kelly; Han Jo Kim; Daniel M Sciubba; Samuel K Cho; David W Polly; Oheneba Boachie-Adjei; Peter D Angevine; Stephen J Lewis; Lawrence G Lenke Journal: Spine Deform Date: 2022-02-23
Authors: H Koller; C Ames; H Mehdian; R Bartels; R Ferch; V Deriven; H Toyone; C Shaffrey; J Smith; W Hitzl; J Schröder; Yohan Robinson Journal: Eur Spine J Date: 2018-11-27 Impact factor: 3.134
Authors: Meghan Cerpa; Lawrence G Lenke; Michael G Fehlings; Christopher I Shaffrey; Kenneth M C Cheung; Leah Yacat Carreon Journal: Global Spine J Date: 2019-05-08
Authors: Rajiv Saigal; Darryl Lau; Sigurd H Berven; Leah Carreon; Mark B Dekutoski; Khaled M Kebaish; Yong Qiu; Yukihiro Matsuyama; Michael Kelly; Benny T Dahl; Hossein Mehdian; Ferran Pellisé; Stephen J Lewis; Kenneth M C Cheung; Christopher I Shaffrey; Michael G Fehlings; Lawrence G Lenke; Christopher P Ames Journal: Spine (Phila Pa 1976) Date: 2021-04-01 Impact factor: 3.468