Unilateral vs. Bilateral Lower Extremity Motor Deficit Following Complex Adult Spinal Deformity Surgery: Is there a Difference in Recovery Up to 2 Year F/U?

Publication date: Available online 14 August 2018

Source: The Spine Journal

Author(s): Alexander Tuchman, Lawrence G. Lenke, Meghan Cerpa, Michael G. Fehlings, Stephen J. Lewis, Christopher I. Shaffrey, Kenneth M.C. Cheung, Leah Yacat Carreon, Mark B. Dekutoski, Frank J. Schwab, Oheneba Boachie-Adjei, Khaled Kebaish, Christopher P. Ames, Yong Qiu, Yukihiro Matsuyama, Benny T. Dahl, Hossein Mehdian, Ferran Pellisé, Sigurd H. Berven

Abstract

Background Context

Scoli-RISK-1 is a multicenter prospective cohort designed to study neurologic outcomes following complex adult spinal deformity (ASD). The effect of unilateral versus bilateral postoperative motor deficits on the likelihood of long term recovery has not been previously studied in this population.

Purpose

Evaluate if bilateral postoperative neurologic deficits have a worse recovery than unilateral deficits.

Study Design

Secondary analysis of a prospective, multicenter, international cohort study.

Methods

In a cohort of 272 patients neurologic decline was defined as deterioration of the American Spinal Injury Association Lower Extremity Motor Scores (LEMS) following surgery. Patients with lower extremity neurologic decline were grouped into unilateral and bilateral cohorts. Differences in demographics, surgical variables, and patient outcome measures between the two cohorts were analyzed.

Results

265 patients had LEMS completed at discharge. Unilateral decline was seen in 32 patients (12%), while 29 (11%) had bilateral symptoms. At 2 years, there was no significant difference in either median LEMS (unilateral 50.0, interquartile range [IQR]: 47.5 to 50.0; bilateral 50.0, IQR: 48.0 to 50.0, p=0.939) or change in LEMS from baseline (unilateral 0.0, IQR: -1.0 to 0.0; bilateral 0.0, IQR: -1.0 to 0.0, p=0.920). In both groups, approximately two-thirds of patients saw recovery to at least their preoperative baseline by two years postoperatively (unilateral n=15, 63%; bilateral n=14, 67%). The mean Scoliosis Research Society-22R (SRS-22R) score at 2 years was 3.7 0.6 versus 3.2 0.6 (p=0.009) for unilateral and bilateral, respectively.

Conclusion

The prognosis for neurologic recovery of new motor deficits following complex adult spinal deformity is similar with both unilateral and bilateral weakness. Despite similar rates of neurologic recovery, patient reported outcomes for those with bilateral motor decline measured by SRS-22R are worse at 2 years after surgery.

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