The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery.

Abstract

INTRODUCTION:

Neurologic 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.

OBJECTIVE:

To prospectively evaluate lower extremity motor function scores (LEMS) before and at 5 years after surgical correction of complex ASD.

DESIGN:

Retrospective analysis of a prospective, multicenter, international observational study.

METHODS:

The 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.

RESULTS:

Seventy-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).

CONCLUSIONS:

In 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.

• Authors: Lawrence G Lenke, Scott L Zuckerman, Meghan Cerpa, Christopher I Shaffrey, Leah Y Carreon, Kenneth M C Cheung, 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, AO Spine Knowledge Forum Deformity and SRS Scoli-RISK-1 Study Group
• Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (Eur Spine J) Vol. 30 Issue 11 Pg. 3243-3254 (11 2021) ISSN: 1432-0932 [Electronic] Germany
• PMID: 34460003 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Topics

• Adult
• Follow-Up Studies
• Humans
• Lower Extremity (surgery)
• Neurosurgical Procedures
• Postoperative Complications (epidemiology, etiology)
• Prospective Studies
• Retrospective Studies
• Spinal Fusion (adverse effects)