Perioperative neurologic complications in adult spinal deformity surgery

Han Jo Kim, Sravisht Iyer, Luke P. Zebala, Michael P. Kelly, Daniel Sciubba, Themistocles S. Protopsaltis, Munish Gupta, Brian J. Neuman, Gregory M. Mundis, Christopher P. Ames, Justin S. Smith, Robert Hart, Douglas Burton, Eric O. Klineberg

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)420-427
Number of pages8
JournalSpine
Volume42
Issue number6
DOIs
StatePublished - Mar 15 2017

Keywords

  • adult spinal deformity
  • decompression
  • interbody fusion
  • neurologic complications
  • nonsurgical complications
  • radiculopathy
  • revision surgery
  • spine surgery
  • surgical complications
  • three-column osteotomy

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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