• Lawrence G Lenke, Michael G Fehlings, Christopher I Shaffrey, Kenneth M C Cheung, Leah Carreon, Mark B Dekutoski, Frank J Schwab, Oheneba Boachie-Adjei, Khaled M Kebaish, Christopher P Ames, Yong Qiu, Yukihiro Matsuyama, Benny T Dahl, Hossein Mehdian, Ferran Pellisé-Urquiza, Stephen J Lewis, and Sigurd H Berven.
• *Columbia University College of Physicians and Surgeons, New York, NY†University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada‡University of Virginia, Charlottesville, VA§The University of Hong Kong, Hong Kong, People's Republic of China¶Norton Leatherman Spine Center, Louisville, KY||The CORE Institute, Sun City West, AZ**Hospital for Special Surgery, New York, NY††The FOCOS Hospital, Pantang West, Republic of Ghana‡‡Johns Hopkins University, Baltimore, MD§§University of California San Francisco, San Francisco, CA¶¶Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China||||Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan##Rigshospitalet, National University of Denmark, Copenhagen, Denmark***University Hospital, Queen's Medical Centre, London, UK†††Hospital Universitari Vall d'Hebron, Barcelona, Spain.
• Spine. 2016 Feb 1; 41 (3): 204-12.

Study DesignProspective, multicenter, international observational study.ObjectiveTo evaluate motor neurologic outcomes in patients undergoing surgery for complex adult spinal deformity (ASD).Summary Of Background DataThe neurologic outcomes after surgical correction for ASD have been reported with significant variability and have not been measured as a primary endpoint in any prospective, multicenter, observational study.MethodsThe primary outcome measure was the change in American Spinal Injury Association (ASIA) Lower Extremity Motor Scores (LEMS) obtained preoperatively, and at hospital discharge, 6 weeks and 6 months postoperatively.ResultsA total of 273 patients with complex ASD underwent surgery at 15 sites worldwide. One patient was excluded for lack of preoperative LEMS. The remaining 272 patients were divided into two groups: normal preoperative LEMS (=50) (Preop NML, N = 204, 75%) and abnormal preoperative LEMS (<50) (Preop ABNML, N = 68, 25%). At hospital discharge, 22.18% of patients showed a decline in LEMS compared with 12.78% who showed an improvement. At 6 weeks, there was a significant change compared with discharge: 17.91% patients showed a decline in LEMS and 16.42% showed an improvement. At 6 months, 10.82% patients showed a decline in preoperative LEMS, 20.52% improvement, and 68.66% maintenance. This was a significant change compared with 6 weeks and at discharge.ConclusionAlthough complex ASD surgery can restore neurologic function in patients with a preoperative neurologic deficit, a significant portion of patients with ASD experienced postoperative decline in LEMS. Measures that can anticipate and reduce the risk of postoperative neurologic complications are warranted.Level Of Evidence3.

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