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Lenke LG, Shaffrey CI, Carreon LY, Cheung KM, Dahl BT, Fehlings MG, Ames CP, Boachie-Adjei O, Dekutoski MB, Kebaish KM, Lewis SJ, Matsuyama Y, Mehdian H, Pellisé F, Qiu Y, Schwab FJ. Lower Extremity Motor Function Following Complex Adult Spinal Deformity Surgery: Two-Year Follow-up in the Scoli-RISK-1 Prospective, Multicenter, International Study. J Bone Joint Surg Am 2018; 100:656-665. [PMID: 29664852 PMCID: PMC5916483 DOI: 10.2106/jbjs.17.00575] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The reported neurologic complication rate following surgery for complex adult spinal deformity (ASD) is variable due to several factors. Most series have been retrospective with heterogeneous patient populations and use of nonuniform neurologic assessments. The aim of this study was to prospectively document lower extremity motor function by means of the American Spinal Injury Association (ASIA) lower extremity motor score (LEMS) before and through 2 years after surgical correction of complex ASD. METHODS The Scoli-RISK-1 study enrolled 272 patients with ASD, from 15 centers, who had undergone primary or revision surgery for a major Cobb angle of ≥80°, corrective osteotomy for congenital spinal deformity or as a revision procedure for any type of deformity, and/or a complex 3-column osteotomy. RESULTS One of 272 patients lacked preoperative data and was excluded from the analysis, and 62 (22.9%) of the remaining 271 patients, who were included, lacked a 2-year postoperative assessment. Patients with no preoperative motor impairment (normal LEMS group; n = 203) had a small but significant decline from the mean preoperative LEMS value (50) to that at 2 years postoperatively (49.66 [95% confidence interval = 49.46 to 49.85]; p = 0.002). Patients who did have a motor deficit preoperatively (n = 68; mean LEMS, 43.79) had significant LEMS improvement at 6 months (47.21, p < 0.001) and 2 years (46.12, p = 0.003) postoperatively. The overall percentage of patients (in both groups combined) who had a postoperative LEMS decline, compared with the preoperative value, was 23.0% at discharge, 17.1% at 6 weeks, 9.9% at 6 months, and 10.0% at 2 years. CONCLUSIONS The percentage of patients who had a LEMS decline (compared with the preoperative score) after undergoing complex spinal reconstructive surgery for ASD was 23.0% at discharge, which improved to 10.0% at 2 years postoperatively. These rates are higher than previously reported, which we concluded was due to the prospective, strict nature of the LEMS testing of patients with these challenging deformities. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lawrence G. Lenke
- Columbia University Medical Center, New York, NY,E-mail address for L.G. Lenke:
| | | | | | | | - Benny T. Dahl
- Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Neurologic Outcomes of Complex Adult Spinal Deformity Surgery: Results of the Prospective, Multicenter Scoli-RISK-1 Study. Spine (Phila Pa 1976) 2016; 41:204-12. [PMID: 26866736 DOI: 10.1097/brs.0000000000001338] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, multicenter, international observational study. OBJECTIVE To evaluate motor neurologic outcomes in patients undergoing surgery for complex adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA The 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. METHODS The 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. RESULTS A 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. CONCLUSION Although 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 EVIDENCE 3.
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Sciubba DM, Yurter A, Smith JS, Kelly MP, Scheer JK, Goodwin CR, Lafage V, Hart RA, Bess S, Kebaish K, Schwab F, Shaffrey CI, Ames CP. A Comprehensive Review of Complication Rates After Surgery for Adult Deformity: A Reference for Informed Consent. Spine Deform 2015; 3:575-594. [PMID: 27927561 DOI: 10.1016/j.jspd.2015.04.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE An up-to-date review of recent literatures and a comprehensive reference for informed consent specific to ASD complications is lacking. The goal of the present study was to determine current complication rates after ASD surgery, in order to provide a reference for informed consent as well as to determine differences between three-column and non-three-column osteotomy procedures to aid in shared decision making. METHODS A review of the literature was conducted using the PubMed database. Randomized controlled trials, nonrandomized trials, cohort studies, case-control studies, and case series providing postoperative complications published in 2000 or later were included. Complication rates were recorded and calculated for perioperative (both major and minor) and long-term complication rates. Postoperative outcomes were all stratified by surgical procedure (ie, three-column osteotomy and non-three-column osteotomy). RESULTS Ninety-three articles were ultimately eligible for analysis. The data of 11,692 patients were extracted; there were 3,646 complications, mean age at surgery was 53.3 years (range: 25-77 years), mean follow-up was 3.49 years (range: 6 weeks-9.7 years), estimated blood loss was 2,161 mL (range: 717-7,034 mL), and the overall mean complication rate was 55%. Specifically, major perioperative complications occurred at a mean rate of 18.5%, minor perioperative complications occurred at a mean rate of 15.7%, and long-term complications occurred at a mean rate of 20.5%. Furthermore, three-column osteotomy resulted in a higher overall complication rate and estimated blood loss than non-three-column osteotomy. CONCLUSIONS A review of recent literatures providing complication rates for ASD surgery was performed, providing the most up-to-date incidence of early and late complications. Providers may use such data in helping to counsel patients of the literature-supported complication rates of such procedures despite the planned benefits, thus obtaining a more thorough informed consent.
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Affiliation(s)
- Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA.
| | - Alp Yurter
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Michael P Kelly
- Department of Orthopedic Surgery, Washington University, 4921 Parkview Place, A 12, St. Louis, MO 63110, USA
| | - Justin K Scheer
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 2210, Chicago, IL 60611, USA
| | - C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street; Meyer Building, Room 7-109, Baltimore, MD 21287, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 1F, New York, NY 10003, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, 3182 SW Sam Jackson Park Rd; Ortho Dept MC: OP31, Portland, OR 97239, USA
| | - Shay Bess
- Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO 80205, USA
| | - Khaled Kebaish
- Department of Orthopaedic Surgery, Johns Hopkins University, 610 North Caroline Street, Suite 5243, Baltimore, MD 21287, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 E 15th Street, Suite 1F, New York, NY 10003, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave, M779 - Department of Neurosurgery, San Francisco, CA 94143, USA
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Yadla S, Maltenfort MG, Ratliff JK, Harrop JS. Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus 2010; 28:E3. [PMID: 20192664 DOI: 10.3171/2009.12.focus09254] [Citation(s) in RCA: 199] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Appreciation of the optimal management of skeletally mature patients with spinal deformities requires understanding of the natural history of the disease relative to expected outcomes of surgical intervention. Appropriate outcome measures are necessary to define the surgical treatment. Unfortunately, the literature lacks prospective randomized data. The majority of published series report outcomes of a particular surgical approach, procedure, or surgeon. The purpose of the current study was to systematically review the present spine deformity literature and assess the available data on clinical and radiographic outcome measurements. METHODS A systematic review of MEDLINE and PubMed databases was performed to identify articles published from 1950 to the present using the following key words: "adult scoliosis surgery," "adult spine deformity surgery," "outcomes," and "complications." Exclusion criteria included follow-up shorter than 2 years and mean patient age younger than 18 years. Data on major curve (coronal scoliosis or lumbar lordosis Cobb angle as reported), major curve correction, Oswestry Disability Index (ODI) scores, Scoliosis Research Society (SRS) instrument scores, complications, and pseudarthroses were recorded. RESULTS Forty-nine articles were obtained and included in this review; 3299 patient data points were analyzed. The mean age was 47.7 years, and the mean follow-up period was 3.6 years. The average major curve correction was 26.6 degrees (for 2188 patients); for 2129 patients, it was possible to calculate average curve reduction as a percentage (40.7%). The mean total ODI was 41.2 (for 1289 patients), and the mean postoperative reduction in ODI was 15.7 (for 911 patients). The mean SRS-30 equivalent score was 97.1 (for 1700 patients) with a mean postoperative decrease of 23.1 (for 999 patients). There were 897 reported complications for 2175 patients (41.2%) and 319 pseudarthroses for 2469 patients (12.9%). CONCLUSIONS Surgery for adult scoliosis is associated with improvement in radiographic and clinical outcomes at a minimum 2-year follow-up. Perioperative morbidity includes an approximately 13% risk of pseudarthrosis and a greater than 40% incidence of perioperative adverse events. Incidence of perioperative complications is substantial and must be considered when deciding optimal disease management. Although the quality of published studies in this area has improved, particularly in the last few years, the current review highlights the lack of routine use of standardized outcomes measures and assessment in the adult scoliosis literature.
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Affiliation(s)
- Sanjay Yadla
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Mac-Thiong JM, Labelle H, Poitras B, Rivard CH, Joncas J. The effect of intraoperative traction during posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2004; 29:1549-54. [PMID: 15247577 DOI: 10.1097/01.brs.0000131421.66635.af] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study comparing patients having traction and a control group not having traction during posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS). OBJECTIVE To evaluate the effect of intraoperative traction on surgical correction of AIS. SUMMARY OF BACKGROUND DATA When the Cotrel-Dubousset instrumentation system was introduced, the use of intraoperative traction was advocated. However, there is no specific report documenting the effect of intraoperative traction on the correction of AIS. METHODS The medical and radiologic records of 140 AIS patients treated by PSIF were reviewed. Forty of these patients had intraoperative traction using a head halter associated with lower extremity skin traction. The radiologic outcome was compared between the two groups intraoperatively (before instrumentation with the first rod) and after surgery using Student t tests (level of significance = 0.05). RESULTS The intraoperative and postoperative corrections of the coronal primary Cobb angle were similar for both groups, although the patients in the traction group had smaller preoperative Cobb angles and more flexible curves and were instrumented with more screws. The postoperative thoracic kyphosis was significantly increased in both groups. The lumbar lordosis at the 1-year follow-up was maintained in the control group, but it was significantly decreased in the traction group. CONCLUSION The authors do not recommend the routine use of intraoperative traction using a head halter combined with skin traction for all AIS patients undergoing PSIF. However, it could be helpful in selected cases, such as in patients having pelvic obliquity and requiring instrumentation of the pelvis.
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