• Lawrence G Lenke, Scott L Zuckerman, Meghan Cerpa, Christopher I Shaffrey, Leah Y Carreon, CheungKenneth M CKMCLi Ka Shing, Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong., Michael P Kelly, Michael G Fehlings, Christopher P Ames, Oheneba Boachie-Adjei, Mark B Dekutoski, Khaled M Kebaish, Stephen J Lewis, Yukihiro Matsuyama, Ferran Pellisé, Yong Qiu, Frank J Schwab, Justin S Smith, and AO Spine Knowledge Forum Deformity and SRS Scoli-RISK-1 Study Group.
• Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, 10032, USA. LL2989@cumc.columbia.edu.
• Eur Spine J. 2021 Nov 1; 30 (11): 3243-3254.

IntroductionNeurologic complications after complex adult spinal deformity (ASD) surgery are important, yet outcomes are heterogeneously reported, and long-term follow-up of actual lower extremity motor function is unknown.ObjectiveTo prospectively evaluate lower extremity motor function scores (LEMS) before and at 5 years after surgical correction of complex ASD.DesignRetrospective analysis of a prospective, multicenter, international observational study.MethodsThe Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers around the world. Inclusion criteria were Cobb angle of > 80°, corrective osteotomy for congenital or revision deformity and/or 3-column osteotomy. Among patients with 5-year follow-up, comparisons of LEMS to baseline and within each follow-up period were made via documented neurologic exams on each patient.ResultsSeventy-seven (28.3%) patients had 5-year follow-up. Among these 77 patients with 5-year follow-up, rates of postoperative LEMS deterioration were: 14.3% hospital discharge, 10.7% at 6 weeks, 6.5% at 6 months, 9.5% at 2 years and 9.3% at 5 years postoperative. During the 2-5 year window, while mean LEMS did not change significantly (-0.5, p = 0.442), eight (11.1%) patients deteriorated (of which 3 were ≥ 4 motor points), and six (8.3%) patients improved (of which 2 were ≥ 4 points). Of the 14 neurologic complications, four (28.6%) were surgery-related, three of which required reoperation. While mean LEMS were not impacted in patients with a major surgery-related complication, mean LEMS were significantly lower in patients with neurologic surgery-related complications at discharge (p = 0.041) and 6 months (p = 0.008) between the two groups as well as the change from baseline to 5 years (p = 0.041).ConclusionsIn 77 patients undergoing complex ASD surgery with 5-year follow-up, while mean LEMS did not change from 2 to 5 years, subtle neurologic changes occurred in approximately 1 in 5 patients (11.1% deteriorated; 8.3% improved). Major surgery-related complication did not result in decreased LEMS; however, those with neurologic surgery-related complications continued to have decreased lower extremity motor function at 5 years postoperative. These results underscore the importance of long-term follow-up to 5 years, using individual motor scores rather than group averages, and comparing outcomes to both baseline and last follow-up.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

20 keywords...

hide…