Incidence and risk factors of post-operative neurological decline after complex adult spinal deformity surgery: results of the scoli-risk-1 study

Publication date: Available online 13 February 2018
Source:The Spine Journal
Author(s): Michael G. Fehlings, So Kato, Lawrence G. Lenke, Hiroaki Nakashima, Narihito Nagoshi, Christopher I. Shaffrey, Kenneth M.C. Cheung, Leah Carreon, Mark B. Dekutoski, Frank J. Schwab, Oheneba Boachie-Adjei, Khaled M. Kebaish, Christopher P. Ames, Yong Qiu, Yukihiro Matsuyama, Benny T. Dahl, Hossein Mehdian, Ferran Pellisé-Urquiza, Stephen J. Lewis, Sigurd H. Berven
Background ContextSignificant variability in neurologic outcomes following surgical correction for adult spinal deformity (ASD) has been reported. Risk factors for decline in neurologic motor outcomes are poorly understood.PurposeThe objective of the present investigation was to identify the risk factors for post-operative neurological motor decline in patients undergoing complex ASD surgery.Study Design/SettingA prospective international multicenter cohort study.Patient SampleFrom September 2011 to October 2012, 272 patients undergoing complex ASD surgery were prospectively enrolled in a multicenter, international cohort study in 15 sites.Outcome MeasuresNeurological decline was defined as any post-operative deterioration in American Spinal Injury Association Lower Extremity Motor Scores (LEMS) compared to pre-operative status.MethodsTo 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. Funds from The Scoliosis Research Society (SRS) and AOSpine International, both nonprofit organizations, and from Norton Healthcare, Louisville, KY, USA, were received in support of this work.ResultsComplete 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 post-operative neurological 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 = 0.005), larger coronal deformity angular ratio [DAR] (OR = 1.1 per 1 unit, 95% CI: 1.0 – 1.2, p = 0.037) and lumbar osteotomy (OR = 3.3, 95% CI: 1.2 – 9.2, p = 0.022) are the three major predictors of neurological decline.ConclusionsTwenty-three percent of patients undergoing complex ASD surgery experienced a post-operative neurological decline. Age, coronal DAR, and lumbar osteotomy were identified as the key contributing factors.



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