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

Mitsuru Yagi, Takehiro Michikawa, Naobumi Hosogane, Nobuyuki Fujita, Eijiro Okada, Satoshi Suzuki, Osahiko Tsuji, Narihito Nagoshi, Takashi Asazuma, Takashi Tsuji, Masaya Nakamura, Morio Matsumoto, Kota Watanabe

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)1364-1370
Number of pages7
JournalSpine
Volume44
Issue number19
DOIs
Publication statusPublished - 01-10-2019

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Activities of Daily Living
Quality of Life
Ambulatory Surgical Procedures
Spinal Cord Injuries
Hospitalization
Multivariate Analysis
Databases
Incidence

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Yagi, M., Michikawa, T., Hosogane, N., Fujita, N., Okada, E., Suzuki, S., ... Watanabe, K. (2019). Risk, Recovery, and Clinical Impact of Neurological Complications in Adult Spinal Deformity Surgery. Spine, 44(19), 1364-1370. https://doi.org/10.1097/BRS.0000000000003080
Yagi, Mitsuru ; Michikawa, Takehiro ; Hosogane, Naobumi ; Fujita, Nobuyuki ; Okada, Eijiro ; Suzuki, Satoshi ; Tsuji, Osahiko ; Nagoshi, Narihito ; Asazuma, Takashi ; Tsuji, Takashi ; Nakamura, Masaya ; Matsumoto, Morio ; Watanabe, Kota. / Risk, Recovery, and Clinical Impact of Neurological Complications in Adult Spinal Deformity Surgery. In: Spine. 2019 ; Vol. 44, No. 19. pp. 1364-1370.
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abstract = "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.",
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Yagi, M, Michikawa, T, Hosogane, N, Fujita, N, Okada, E, Suzuki, S, Tsuji, O, Nagoshi, N, Asazuma, T, Tsuji, T, Nakamura, M, Matsumoto, M & Watanabe, K 2019, 'Risk, Recovery, and Clinical Impact of Neurological Complications in Adult Spinal Deformity Surgery', Spine, vol. 44, no. 19, pp. 1364-1370. https://doi.org/10.1097/BRS.0000000000003080

Risk, Recovery, and Clinical Impact of Neurological Complications in Adult Spinal Deformity Surgery. / Yagi, Mitsuru; Michikawa, Takehiro; Hosogane, Naobumi; Fujita, Nobuyuki; Okada, Eijiro; Suzuki, Satoshi; Tsuji, Osahiko; Nagoshi, Narihito; Asazuma, Takashi; Tsuji, Takashi; Nakamura, Masaya; Matsumoto, Morio; Watanabe, Kota.

In: Spine, Vol. 44, No. 19, 01.10.2019, p. 1364-1370.

Research output: Contribution to journalArticle

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T1 - Risk, Recovery, and Clinical Impact of Neurological Complications in Adult Spinal Deformity Surgery

AU - Yagi, Mitsuru

AU - Michikawa, Takehiro

AU - Hosogane, Naobumi

AU - Fujita, Nobuyuki

AU - Okada, Eijiro

AU - Suzuki, Satoshi

AU - Tsuji, Osahiko

AU - Nagoshi, Narihito

AU - Asazuma, Takashi

AU - Tsuji, Takashi

AU - Nakamura, Masaya

AU - Matsumoto, Morio

AU - Watanabe, Kota

PY - 2019/10/1

Y1 - 2019/10/1

N2 - 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.

AB - 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.

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Yagi M, Michikawa T, Hosogane N, Fujita N, Okada E, Suzuki S et al. Risk, Recovery, and Clinical Impact of Neurological Complications in Adult Spinal Deformity Surgery. Spine. 2019 Oct 1;44(19):1364-1370. https://doi.org/10.1097/BRS.0000000000003080