The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery
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 (L...
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Veröffentlicht in: | European spine journal 2021-11, Vol.30 (11), p.3243-3254 |
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Sprache: | eng |
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Zusammenfassung: | 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. |
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ISSN: | 0940-6719 1432-0932 |
DOI: | 10.1007/s00586-021-06969-z |