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 journalArticle

16 Citations (Scopus)

Abstract

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)
JournalSpine
DOIs
StateAccepted/In press - Jul 7 2016

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Nervous System
Incidence
Osteotomy
Neurosurgical Procedures
Radiculopathy
Decompression
Spine
Multivariate Analysis
Stroke
Demography

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Perioperative Neurologic Complications in Adult Spinal Deformity Surgery : Incidence and Risk factors in 564 Patients. / The International Spine Study Group (ISSG); Gupta, Munish.

In: Spine, 07.07.2016.

Research output: Contribution to journalArticle

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title = "Perioperative Neurologic Complications in Adult Spinal Deformity Surgery: Incidence and Risk factors in 564 Patients",
abstract = "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",
author = "{The International Spine Study Group (ISSG)} and Kim, {Han Jo} and Sravisht Iyer and Zebala, {Luke P.} and Kelly, {Michael P.} and Daniel Sciubba and Munish Gupta and Munish Gupta and Neuman, {Brian J.} and Mundis, {Gregory M.} and Ames, {Christopher P.} and Smith, {Justin S.} and Robert Hart and Douglas Burton and Klineberg, {Eric Otto}",
year = "2016",
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doi = "10.1097/BRS.0000000000001774",
language = "English (US)",
journal = "Spine",
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T2 - Incidence and Risk factors in 564 Patients

AU - The International Spine Study Group (ISSG)

AU - Kim, Han Jo

AU - Iyer, Sravisht

AU - Zebala, Luke P.

AU - Kelly, Michael P.

AU - Sciubba, Daniel

AU - Gupta, Munish

AU - Gupta, Munish

AU - Neuman, Brian J.

AU - Mundis, Gregory M.

AU - Ames, Christopher P.

AU - Smith, Justin S.

AU - Hart, Robert

AU - Burton, Douglas

AU - Klineberg, Eric Otto

PY - 2016/7/7

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N2 - 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

AB - 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

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