Perioperative Neurologic Complications in Adult Spinal Deformity Surgery: Incidence and Risk Factors in 564 Patients. Issue 6 (15th March 2017)

• Record Type: Journal Article
• Authors: Kim, Han Jo; Iyer, Sravisht; Zebala, Luke P.; Kelly, Michael P.; Sciubba, Daniel; Protopsaltis, Themistocles S.; Gupta, Munish; Neuman, Brian J.; Mundis, Gregory M.; Ames, Christopher P.; Smith, Justin S.; Hart, Robert; Burton, Douglas; Klineberg, Eric O.
• Is Part Of: Spine. Volume 42:Issue 6(2017)
• Publication Date: 2017-03-15
• Subjects: adult spinal deformity -- decompression -- interbody fusion -- neurologic complications -- nonsurgical complications -- radiculopathy -- revision surgery -- spine surgery -- surgical complications -- three-column osteotomy; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000001774
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : 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. Level of Evidence: 3