So Kato1, Michael G Fehlings1, Stephen J Lewis1, Lawrence G Lenke2, Christopher I Shaffrey3, Kenneth M C Cheung4, Leah Y Carreon5, Mark B Dekutoski6, Frank J Schwab7, Oheneba Boachie-Adjei8, Khaled M Kebaish9, Christopher P Ames10, Yong Qiu11, Yukihiro Matsuyama12, Benny T Dahl13,14, Hossein Mehdian15, Ferran Pellisé16, Sigurd H Berven10. 1. University of Toronto Spine Program and Toronto Western Hospital, Toronto, Ontario, Canada. 2. Columbia University College of Physicians and Surgeons, New York, NY. 3. University of Virginia, Charlottesville, VA. 4. The University of Hong Kong, Pokfulam, Hong Kong, People's Republic of China. 5. Norton Leatherman Spine Center, Louisville, KY. 6. The CORE Institute, Sun City West, AZ. 7. Hospital for Special Surgery, New York, NY. 8. The FOCOS Hospital, Pantang West, Republic of Ghana. 9. Johns Hopkins University, Baltimore, MD. 10. University of California San Francisco, San Francisco, CA. 11. Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China. 12. Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. 13. Rigshospitalet, National University of Denmark, Copenhagen, Denmark. 14. Texas Children's Hospital, Houston, TX. 15. University Hospital, Queen's Medical Centre, Nottingham, UK. 16. Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Abstract
STUDY DESIGN: A subanalysis from a prospective, multicenter, international cohort study in 15 sites (Scoli-RISK-1). OBJECTIVE: To report detailed information regarding the severity of neurological decline related to complex adult spine deformity (ASD) surgery and to examine outcomes based on severity. SUMMARY OF BACKGROUND DATA: Postoperative neurological decline after ASD surgeries can occur due to nerve root(s) or spinal cord dysfunction. The impact of decline and the pattern of recovery may be related to the anatomic location and the severity of the injury. METHODS: An investigation of 272 prospectively enrolled complex ASD surgical patients with neurological status measured by American Spinal Injury Association Lower Extremity Motor Scores (LEMS) was undertaken. Postoperative neurological decline was categorized into "major" (≥5 points loss) versus "minor" (<5 points loss) deficits. Timing and extent of recovery in LEMS were investigated for each group. RESULTS: Among the 265 patients with LEMS available at discharge, 61 patients (23%) had neurological decline, with 20 (33%) experiencing major decline. Of note, 90% of the patients with major decline had deficits in three or more myotomes. Full recovery was seen in 24% at 6 weeks and increased to 65% at 6 months. However, 34% continued to experience some neurological decline at 24 months, with 6% demonstrating no improvement. Of 41 patients (67%) with minor decline, 73% had deficits in one or two myotomes. Full recovery was seen in 49% at 6 weeks and increased to 70% at 6 months. Of note, 26% had persistence of some neurological deficit at 24 months, with 18% demonstrating no recovery. CONCLUSION: In patients undergoing complex ASD correction, a rate of postoperative neurological decline of 23% was noted with 33% of these being "major." Although most patients showed substantial recovery by 6 months, approximately one-third continued to experience neurological dysfunction. LEVEL OF EVIDENCE: 2.
STUDY DESIGN: A subanalysis from a prospective, multicenter, international cohort study in 15 sites (Scoli-RISK-1). OBJECTIVE: To report detailed information regarding the severity of neurological decline related to complex adult spine deformity (ASD) surgery and to examine outcomes based on severity. SUMMARY OF BACKGROUND DATA: Postoperative neurological decline after ASD surgeries can occur due to nerve root(s) or spinal cord dysfunction. The impact of decline and the pattern of recovery may be related to the anatomic location and the severity of the injury. METHODS: An investigation of 272 prospectively enrolled complex ASD surgical patients with neurological status measured by American Spinal Injury Association Lower Extremity Motor Scores (LEMS) was undertaken. Postoperative neurological decline was categorized into "major" (≥5 points loss) versus "minor" (<5 points loss) deficits. Timing and extent of recovery in LEMS were investigated for each group. RESULTS: Among the 265 patients with LEMS available at discharge, 61 patients (23%) had neurological decline, with 20 (33%) experiencing major decline. Of note, 90% of the patients with major decline had deficits in three or more myotomes. Full recovery was seen in 24% at 6 weeks and increased to 65% at 6 months. However, 34% continued to experience some neurological decline at 24 months, with 6% demonstrating no improvement. Of 41 patients (67%) with minor decline, 73% had deficits in one or two myotomes. Full recovery was seen in 49% at 6 weeks and increased to 70% at 6 months. Of note, 26% had persistence of some neurological deficit at 24 months, with 18% demonstrating no recovery. CONCLUSION: In patients undergoing complex ASD correction, a rate of postoperative neurological decline of 23% was noted with 33% of these being "major." Although most patients showed substantial recovery by 6 months, approximately one-third continued to experience neurological dysfunction. LEVEL OF EVIDENCE: 2.
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: 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