131. Risk factors that decrease complete recovery in idiopathic scoliosis surgery associated neurological injuries

Abstract

<h3>BACKGROUND CONTEXT</h3> Neurological injuries (NI) are devastating complications of idiopathic scoliosis (IS) surgeries. The risk factors for these injuries have been well studied in the literature. However, the prognosis and the factors that impact the prognosis of NIs have been poorly studied. <h3>PURPOSE</h3> The purpose of this study was to summarize the prognosis of the documented 8-year NIs associated with IS surgeries from the Scoliosis Research Society Morbidity and Mortality (SRS M&M) database. <h3>STUDY DESIGN/SETTING</h3> Retrospective study conducted querying the SRS M&M database between 2009 and 2017 for idiopathic scoliosis population who had perioperative neurological deficits from scoliosis surgery. <h3>PATIENT SAMPLE</h3> n= 418; males (n=93; 22.4%), females (n=322, 77.6%), 3 unknown. <h3>OUTCOME MEASURES</h3> To determine the risk factors that decrease the complete recovery of neurological injuries. <h3>Methods</h3> Analyses were made to compare the correlation between the extent of neurological recovery (complete, partial and no change) and time of event occurrence (intraoperative, acute postoperative (<24hrs) and delayed postoperative >24hrs), intraoperative neurophysiological monitoring (IONM) used (yes/no), intra- and postoperative hypotension (yes/no), type of neurological injury (cord, root or both), type of cord injury (complete or incomplete). Chi-square and ANOVA tests were used for analyses. <h3>Results</h3> Data showed: EOIS (n=30), adolescent IS (n=244) and adult IS (n=144); average estimated blood loss, 1.9L; and average follow-up: 180 days. Intraoperative neuromonitoring (IONM) was used in 351 (84%), intraoperative hypotension observed in 73 (18%), and postoperative hypotension observed in 32 (8%). The majority of the NIs were intraoperative 168 (40.2%); postoperative (<24hrs.) 159 (38%); delayed (> 24 hrs) 91 (21.8%). Incomplete cord injuries were 178 (47.7%), complete cord injuries 53 (14.2%), root injuries 142 (38.1%) and no information for 45 patients. Injury level noticed at: cervical=20 (4.8%); thoracic=181 (43.3%), lumbar=187 (44.7%), sacrum=5 (1.2%) and unknown in 25 (6.0%) patients. Complete recovery was noticed in 269 patients (64.4%), partial recovery in 125 patients (29.9%), no recovery in 24 patients (5.7%). Average follow-up length was no different among recovery types: complete=190 days; partial=174 days; and no change=174 days, p=0.35. Complete NI recovery rate was significantly lower for adult IS patients (n= 67, 46.5%) vs EOIS (n=24, 80%) and AIS (n=178, 73%), (p<0.001). There was a significant increase in no recovery NIs status rates for complete cord injuries (n=13, 24.5%) vs incomplete cord (n=4, 2.2%) and root injuries (n=4, 2.8%), p<0.001), IONM abnormalities decreased complete recovery rates for intraoperative NIs (n=4, 33% vs n=109, (76.8%), p=0.001. There was a trend toward lower complete recovery rates in patients who did not use IONM for intraoperative NIs (p=0.06). <h3>Conclusions</h3> Lower complete NI recovery rates were observed in adult IS patients. Complete cord injuries reduced NIs complete recovery rate. IONM signal abnormalities have a potential effect on intraoperative NI prognosis, but not on postoperative or delayed NI prognosis. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.