Mitsuru Yagi1,2,3, Takehiro Michikawa4, Naobumi Hosogane3,5, Nobuyuki Fujita1,3, Eijiro Okada1,3, Satoshi Suzuki1,3, Osahiko Tsuji1,3, Narihito Nagoshi1,3, Takashi Asazuma2, Takashi Tsuji3,6, Masaya Nakamura1,3, Morio Matsumoto1,3, Kota Watanabe1,3. 1. Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan. 2. Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan. 3. Keio Spine Research Group, Tokyo, Japan. 4. Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan. 5. Department of Orthopedic Surgery, Kyorin University School of Medicine, Tokyo, Japan. 6. Department of Orthopedic Surgery, Fujita Health University, Aichi, Japan.
Abstract
STUDY DESIGN: Multicenter retrospective case series. OBJECTIVE: To report the risks, recovery, and clinical impact of neurological complications (NCs) in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Although recent studies have reported the incidence of NCs in ASD surgery, few have addressed the recovery from and clinical impacts of NC. METHODS: We reviewed records from a multicenter database for 285 consecutive surgically treated ASD patients who had reached a 2-year follow-up. NCs were categorized as sensory only or motor deficit (MD). Recovery was noted as none, partial, or complete, during hospitalization and at every postoperation visit. Uni- and multivariate risk analyses were performed to identify risk factors for MD. RESULTS: NC developed in 29 (10%) patients within 30 days of surgery, of which 11 were permanent deficits (seven no recovery, and four partial recovery). MD developed in 14 (5%) patients, including one spinal cord injury. Seven MD patients required physical assistance at the latest follow-up. While NC patients experienced significant improvements in health-related quality of life at the 2-year follow-up, the health-related quality of life was significantly worse for the NC versus no-NC group at this time point. Univariate analyses revealed that Schwab-SRS types N and L, pelvic tilt, modified frailty index physical function, and an inferior SRS22 function domain at baseline were risk factors for MD. Among them, modified frailty index physical function, which represented a preoperative decline in activities of daily living, was identified as an independent risk factor for MD (OR: 4.0, 95% CI: 1.2-13.5, P = 0.03). CONCLUSIONS: NC developed in 10% of ASD surgery patients, with permanent deficits occurring in 4%. Half of the patients who developed MD required physical assistance, which contributed to the inferior clinical outcomes. Surgical intervention should be considered before severe activities of daily living decline to prevent NCs. LEVEL OF EVIDENCE: 4.
STUDY DESIGN: Multicenter retrospective case series. OBJECTIVE: To report the risks, recovery, and clinical impact of neurological complications (NCs) in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Although recent studies have reported the incidence of NCs in ASD surgery, few have addressed the recovery from and clinical impacts of NC. METHODS: We reviewed records from a multicenter database for 285 consecutive surgically treated ASDpatients who had reached a 2-year follow-up. NCs were categorized as sensory only or motor deficit (MD). Recovery was noted as none, partial, or complete, during hospitalization and at every postoperation visit. Uni- and multivariate risk analyses were performed to identify risk factors for MD. RESULTS: NC developed in 29 (10%) patients within 30 days of surgery, of which 11 were permanent deficits (seven no recovery, and four partial recovery). MD developed in 14 (5%) patients, including one spinal cord injury. Seven MD patients required physical assistance at the latest follow-up. While NC patients experienced significant improvements in health-related quality of life at the 2-year follow-up, the health-related quality of life was significantly worse for the NC versus no-NC group at this time point. Univariate analyses revealed that Schwab-SRS types N and L, pelvic tilt, modified frailty index physical function, and an inferior SRS22 function domain at baseline were risk factors for MD. Among them, modified frailty index physical function, which represented a preoperative decline in activities of daily living, was identified as an independent risk factor for MD (OR: 4.0, 95% CI: 1.2-13.5, P = 0.03). CONCLUSIONS: NC developed in 10% of ASD surgery patients, with permanent deficits occurring in 4%. Half of the patients who developed MD required physical assistance, which contributed to the inferior clinical outcomes. Surgical intervention should be considered before severe activities of daily living decline to prevent NCs. LEVEL OF EVIDENCE: 4.
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