167. Neurologic outcomes of adult spinal deformity patients with baseline preoperative lower extremity weakness: will they improve following surgery?

Abstract

<h3>BACKGROUND CONTEXT</h3> Adult spinal deformity (ASD) patients undergoing surgery risk neurological decline following surgery. However, surgery may be the key in improving outcomes in patients starting with lower extremity motor deficits at baseline (BL). We aim to analyze the improvement in neurological outcomes of ASD patients undergoing spinal reconstruction with BL and 6-week postoperative lower extremity motor scores (LEMS). <h3>PURPOSE</h3> The aim of this study is to analyze the improvement in neurological outcomes of adult patients undergoing deformity surgery with baseline abnormal LEMS. <h3>STUDY DESIGN/SETTING</h3> Multicenter, prospective cohort. <h3>PATIENT SAMPLE</h3> A total of 205 patients were included in the study. <h3>OUTCOME MEASURES</h3> Patient and procedural factors that lead to the improvement in neurological outcomes of adult patients undergoing deformity surgery with baseline abnormalLEMS. <h3>METHODS</h3> ASD patients ages = 18 were prospectively studied from 2018-2021. All patients underwent an instrumented PSF with a few also having an ASF of the lumbar spine. Patients were dichotomized based on BL LEMS (NML = 50, ABML < 50). The ABNML group was then dichotomized based on whether LEMS improved overall from BL or experienced no change or declined by first postoperative follow-up (PO) and various factors were analyzed and compared using standard statistical tests. <h3>RESULTS</h3> Of the 205 patients evaluated, 134 (65.4%) were NML and 71 were ABNML (34.3%) at BL. Among the 71 patients with ABML LEMS at BL, 49% (N=35) improved to NML levels, 21% (N=15) improved from BL levels but not to NML, 20% (N=14) remained the same, and 10% (N=7) declined further at 6week PO. Compared to ABNML patients with no change or a decline in LEMS at first PO, patients who improved overall (70%; N=50) had significantly more decompressions performed (86% vs 57%; p=0.0092), and had more PCOs performed intraoperatively (90% vs 62%, p=0.0074). There were no statistical differences between the groups in age, BL LEMS, BMI, total instrumented vertebrae (TIV), EBL, and OR time. Overall, the number of patients with NML LEMS at 6 weeks PO increased by 7.5% (65.4% to 70.2%; p<.0001). <h3>CONCLUSIONS</h3> Seventy percent of patients with ABML LEMS at BL improved their motor strength by the first PO visit, while 30% stayed the same or declined. ABNML patients who improved from BL had significantly more decompressions performed and, surprisingly, more PCOs performed. Interestingly, patient factors between the two groups demonstrated no statistical differences further highlighting that improvement may be influenced by the differences in surgical techniques. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.