234. Neurologic complications after adult spinal deformity surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Adult spinal deformity (ASD) surgery can entail extensive correction for rigid deformities with an associated risk for neurologic complications. Existing reports of neurologic complications after ASD surgery often utilize multicenter databases with considerable heterogeneity. The rate of recovery at long-term follow-up has been less widely examined. We sought to describe the incidence of neurologic complications and rate of resolution. <h3>PURPOSE</h3> To assess the rate of complete resolution of neurologic complications after ASD surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively collected database. <h3>PATIENT SAMPLE</h3> This study included 949 patients (Age: 45 ± 24 y; mFI: .41 ± .67; Levels fused: 10 ± 4) underwent ASD surgery. <h3>OUTCOME MEASURES</h3> Outcomes evaluated at a mean of 48.9 months of follow-up were the rate of neurologic complications and resolution of neurologic injury. <h3>METHODS</h3> Neurologic complications were identified and characterized in a cohort of patients undergoing ASD surgery. The rate of resolution of neurologic injury was assessed until long-term follow-up. Strength grading was assessed at each postoperative visit until final follow-up. Patient and surgical risk factors were assessed for their relationship with incurrence of a neurologic complication. <h3>RESULTS</h3> The neurologic complication rate was 18.9% (179/949). Of the 179 neurologic complications, 150 (83.8%) were new onset postoperative radiculopathies with pain or sensory deficit, 21 (11.7%) were radiculopathies with motor deficit, 7 (3.9%) were spinal cord injuries, and 1 (0.6%) was cauda equina syndrome. At final follow-up, 97/179 patients (54.2%) had either complete resolution (n=53, 29.6%) or partial resolution (n=44, 24.6%) of the neurologic injury, and 82 patients had no resolution (45.8%). Of those who had a postoperative motor deficit, mean strength grading at final follow-up was 4.14 ± 1.46. Of the 179 patients, 30 (16.8%) required revision surgery. Age >70, current smoking, revision surgery, higher BMI (28.6 vs 24.3 mg/k2, p<0.0001), higher preoperative SVA (103.8 mm vs 71.4 mm, p<0.0001) and greater correction of SVA (34.4 mm vs 17.8 mm, p=0.004) were associated with neurologic complications. Two attending spine surgeons were present for 18.9% of cases with no effect on rate of neurologic complications. BMI (OR:1.04, p=0.029), revision surgery (OR:2.5, p<0.0001), and PSO (OR:2.2, 0.007) were predictors of neurologic complications. <h3>CONCLUSIONS</h3> We report an overall neurologic complication rate of 18.9% after ASD surgery with a 29.6% rate of complete resolution and 24.6% rate of partial resolution. Of total patients, 11.7% had an associated motor deficit with mean strength grade of 4.14 at final follow-up. Higher BMI and history of revision surgery were predictors of neurologic complications. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.