TY - JOUR
T1 - Perioperative neurologic complications in adult spinal deformity surgery
AU - Kim, Han Jo
AU - Iyer, Sravisht
AU - Zebala, Luke P.
AU - Kelly, Michael P.
AU - Sciubba, Daniel
AU - Protopsaltis, Themistocles S.
AU - Gupta, Munish
AU - Neuman, Brian J.
AU - Mundis, Gregory M.
AU - Ames, Christopher P.
AU - Smith, Justin S.
AU - Hart, Robert
AU - Burton, Douglas
AU - Klineberg, Eric O.
PY - 2017/3/15
Y1 - 2017/3/15
N2 - Study Design. Prognostic study - case controlled. Objective. Describe the rate of neurologic complications in adult spinal deformity surgery and describe the effect of these complications on clinical outcomes. Summary of Background Data. The incidence of neurologic complications and the risk factors for neurologic complications have not been reported in a large series of patients with adult spinal deformity (ASD). Existing series include a mixed patient cohort undergoing different types of spine surgery. Methods. Patients with ASD undergoing surgery between 2008 and 2014 were analyzed. Patients with neurologic complications were identified; demographics, operative details, and radiographic and clinical outcomes were compared. A subanalysis of those with surgical and nonsurgical (e.g., stroke) neurologic complications was performed. Statistical analysis included t tests or χ 2 tests as appropriate and a multivariate analysis. A P value of less than 0.025 was considered significant. Results. A total of 564 patients met the inclusion criteria. The average age was 57 years. There were a total of 116 neurologic complications in 99 patients (17.6%). There were 88 surgical procedure-related neurologic complications in 77 patients (13.7%) and 28 nonsurgical neurologic complications in 28 patients (5.0%). The most common complications were radiculopathy (30%), motor deficits (22%), mental status changes (12%), and sensory deficits (12%). Revisions (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.2-2.4) and interbody fusions (OR 2.1, 95% CI 1.4-3.2) were associated with an increased risk of neurologic complications. Decompression and osteotomies (including three-column osteotomies) did not increase the risk of neurologic complications. Patients with neurologic complications were not more likely to sustain other complications; however, they were more likely to undergo another operation during the follow-up period (OR 1.9, 95% CI 1.3-2.8). Conclusion. The overall incidence of neurologic complications in ASD surgery was 17.6%. The incidence of surgical neurologic complications was 13.7%. There was a higher risk of neurologic complications in revision cases and in cases in which interbody fusion was required.
AB - Study Design. Prognostic study - case controlled. Objective. Describe the rate of neurologic complications in adult spinal deformity surgery and describe the effect of these complications on clinical outcomes. Summary of Background Data. The incidence of neurologic complications and the risk factors for neurologic complications have not been reported in a large series of patients with adult spinal deformity (ASD). Existing series include a mixed patient cohort undergoing different types of spine surgery. Methods. Patients with ASD undergoing surgery between 2008 and 2014 were analyzed. Patients with neurologic complications were identified; demographics, operative details, and radiographic and clinical outcomes were compared. A subanalysis of those with surgical and nonsurgical (e.g., stroke) neurologic complications was performed. Statistical analysis included t tests or χ 2 tests as appropriate and a multivariate analysis. A P value of less than 0.025 was considered significant. Results. A total of 564 patients met the inclusion criteria. The average age was 57 years. There were a total of 116 neurologic complications in 99 patients (17.6%). There were 88 surgical procedure-related neurologic complications in 77 patients (13.7%) and 28 nonsurgical neurologic complications in 28 patients (5.0%). The most common complications were radiculopathy (30%), motor deficits (22%), mental status changes (12%), and sensory deficits (12%). Revisions (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.2-2.4) and interbody fusions (OR 2.1, 95% CI 1.4-3.2) were associated with an increased risk of neurologic complications. Decompression and osteotomies (including three-column osteotomies) did not increase the risk of neurologic complications. Patients with neurologic complications were not more likely to sustain other complications; however, they were more likely to undergo another operation during the follow-up period (OR 1.9, 95% CI 1.3-2.8). Conclusion. The overall incidence of neurologic complications in ASD surgery was 17.6%. The incidence of surgical neurologic complications was 13.7%. There was a higher risk of neurologic complications in revision cases and in cases in which interbody fusion was required.
KW - adult spinal deformity
KW - decompression
KW - interbody fusion
KW - neurologic complications
KW - nonsurgical complications
KW - radiculopathy
KW - revision surgery
KW - spine surgery
KW - surgical complications
KW - three-column osteotomy
UR - http://www.scopus.com/inward/record.url?scp=84978134195&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000001774
DO - 10.1097/BRS.0000000000001774
M3 - Article
C2 - 27398890
AN - SCOPUS:84978134195
SN - 0362-2436
VL - 42
SP - 420
EP - 427
JO - Spine
JF - Spine
IS - 6
ER -