Perioperative Neurologic Complications in Adult Spinal Deformity Surgery: Incidence and Risk factors in 564 Patients

The International Spine Study Group (ISSG), Munish Gupta

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


STUDY DESIGN.: Prognostic Study – Case Controlled. OBJECTIVE.: Describe the rate of neurologic complications in adult spinal deformity surgery and describe the impact of these complications on clinical outcomes. SUMMARY OF BACKGROUND DATA.: The incidence of neurologic complications and the risk factors for neurologic complications has 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 2008–2014 were analyzed. Patients with neurologic complications were identified; demographics, operative details, radiographic, clinical outcomes were compared. A sub-analysis of those with surgical and non-surgical (e.g. stroke) neurologic complications was performed. Statistical analysis included t-tests or X tests as appropriate and a multivariate analysis. A p-value of less than 0.025 was considered significant. RESULTS.: 564 patients met the inclusion criteria. The average age was 57. 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 non-surgical 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 (OR 1.7, 95% 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). CONCLUSIONS.: 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 where interbody fusion was required.Level of Evidence: 3

Original languageEnglish (US)
StateAccepted/In press - Jul 7 2016

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine


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