285. The impact of postoperative neurologic complications on recovery kinetics in cervical deformity surgery

Abstract

BACKGROUND CONTEXT While corrective procedures for cervical deformity (CD) have significantly advanced, little is known what impact neurologic sequlae have on the postoperative recovery process. PURPOSE Investigate which neurologic complications affect clinical outcomes the most following CD surgery. STUDY DESIGN/SETTING Retrospective review of a prospective multicenter adult cervical deformity database. PATIENT SAMPLE A total of 66 operative adult CD patients. OUTCOME MEASURES Neurologic complication rates and Integrated Health State for the Neck Disability Index (NDI), EuroQol-5D (EQ-5D), and the Modified Japanese Orthopedic Association score (mJOA). METHODS CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4cm, or CBVA>25°)>18yr with follow up surgical and HRQL data were included. Descriptive analyses assessed demographics. Neuro comps assessed were: C5 motor deficit, central neuro deficit, nerve root motor deficits, nerve sensory deficits, radiculopathy and spinal cord deficits. Neuro comps were classified as major (M) or minor, then: intra-operative, before discharge, before 30 days, before 90 days, and after 90 days. The rates of persistent neurologic deficits were assessed at 1 and 2 years. HRQL outcomes were assessed at 3M, 6M, 1Y and 2Y. Integrated health state (IHS) for the NDI, EQ5D, and mJOA were assessed using all follow up time points. RESULTS A total of 66 operative CD patients were included. Baseline demo and surgery data: 61 years old, 63% female, BMI 29.7, op time 531.6 ± 275.5, EBL 924.2 ± 729.5, 49% posterior only approach, 18% anterior only approach, 33% combined. 34 (21%) patients experienced a total of 31 neurologic complications in the postoperative period (15M). In total, there were 7 radiculopathy, 6 motor deficits, 6 sensory deficits, 5 C5 motor deficits, 2 central neuro deficits, 2 spinal cord deficits, and 2 other. Motor deficits were the most common major complication (8), 4 of which were C5. Of the intraoperative complications, there were 3M, while 23% of patients had complications before discharge (5M). A total of 39% of neurologic complications occurred before 30 days (7M) and 71% before 90 days (12M), 16% were after 90 days (2M). A total of 12% of neuro comp patients went on to have revision surgery within 6 months, and 18% within 2 years. While normalized 6M mJOA scores were worse between neuro comp and no comp patients (1.00 ± 0.12 vs 1.11 ± 0.19, p=0.024), there was no significant difference in 2Y IHS for the NDI, EQ5D or mJOA (all p>0.05). When assessing individual comps, central neurologic deficits and spinal cord deficit patients had the worst outcomes at 1Y (2.6 and 1.8 times worse normalized NDI scores, p=0.04, no improvement in EQ5D, 8% decrease in EQ5D). Patients with sensory deficits had the best NDI and EQ5D outcomes at 1Y (31% decrease in NDI, 8% increase in EQ5D). One-half of neuro comp patients had persistent neurologic deficits at 1Y, and 21% at 2Y, however, there was no difference in outcomes at any time point (all p>0.05). Experiencing a nerve sensory deficit or spinal cord deficit correlated with revision surgery (r=0.241, 0.283, p CONCLUSIONS A total of 21% of patients undergoing CD surgery experienced a neurologic complication, with 71% occurring within 6 months. While patients who experienced any neurologic complication had worse mJOA scores at 6M, there was no significant difference in recovery kinetics at 2Y. Of the neurologic complications, central neurologic deficits and spinal cord deficits were the most detrimental. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.