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Risk, Recovery, and Clinical Impact of Neurological Complications in Adult Spinal Deformity Surgery

Yagi, Mitsuru MD, PhD∗,†,‡; Michikawa, Takehiro MD, PhD§; Hosogane, Naobumi MD, PhD‡,¶; Fujita, Nobuyuki MD, PhD∗,‡; Okada, Eijiro MD, PhD∗,‡; Suzuki, Satoshi MD, PhD∗,‡; Tsuji, Osahiko MD, PhD∗,‡; Nagoshi, Narihito MD, PhD∗,‡; Asazuma, Takashi MD, PhD; Tsuji, Takashi MD, PhD‡,||; Nakamura, Masaya MD, PhD∗,‡; Matsumoto, Morio MD, PhD∗,‡; Watanabe, Kota MD, PhD∗,‡

doi: 10.1097/BRS.0000000000003080

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

The neurological complication (NC) rate in surgery for ASD was 10% of 285 multicentered cases. NC patients exhibited worse clinical outcomes, partly because many required physical assistance. Preoperative decline in activities of daily living (ADL) was a risk factor for motor deficit. ASD surgery should be considered before ADL decline.

Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan

Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan

Keio Spine Research Group, Tokyo, Japan

§Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan

Department of Orthopedic Surgery, Kyorin University School of Medicine, Tokyo, Japan

||Department of Orthopedic Surgery, Fujita Health University, Aichi, Japan.

Address correspondence and reprint requests to Kota Watanabe, MD, PhD, 35 Shinanomachi, Shinjyuku, Tokyo, Japan; E-mail:

Received 8 January, 2019

Revised 22 February, 2019

Accepted 25 March, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.