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Patient and procedural risk factors for decline in lower-extremity motor scores following adult spinal deformity surgery

Sarthak Mohanty Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, New York;

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Fthimnir M. Hassan Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, New York;

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Lawrence G. Lenke Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, New York;

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Douglas Burton Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas;

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Alan H. Daniels Department of Orthopaedic Surgery, University Orthopedics, Providence, Rhode Island;

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Munish C. Gupta Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri;

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Khaled M. Kebaish Department of Orthopaedic Surgery, Johns Hopkins Medical Institute, Baltimore, Maryland;

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Michael Kelly Department of Orthopaedic Surgery, Rady Children’s Hospital, San Diego, California;

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Han Jo Kim Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York;

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Eric O. Klineberg Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California;

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Peter G. Passias Department of Orthopaedic Surgery, New York University Langone Medical Center, New York, New York;

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Themistocles Protopsaltis Department of Orthopaedic Surgery, New York University Langone Medical Center, New York, New York;

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Frank Schwab Department of Orthopaedic Surgery, Northwell Health Lenox Hill, New York, New York;

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Christopher I. Shaffrey Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;

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Justin S. Smith Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and

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Breton G. Line Department of Spine Surgery, Denver International Spine Clinic, Denver, Colorado

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Renaud Lafage Department of Orthopaedic Surgery, Northwell Health Lenox Hill, New York, New York;

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Virginie Lafage Department of Orthopaedic Surgery, Northwell Health Lenox Hill, New York, New York;

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Shay Bess Department of Spine Surgery, Denver International Spine Clinic, Denver, Colorado

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MD , on behalf of the International Spine Study Group
Publication Date:
28 Apr 2023
Page Range:
157–167
Volume/Issue:
Volume 39: Issue 2
DOI link:
https://doi.org/10.3171/2023.3.SPINE221311
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OBJECTIVE

The purpose of this study was to discern factors that differentiate patients who experience postoperative lower-extremity motor function decline in the early postoperative period.

开云体育世界杯赔率

成人脊柱畸形(ASD)病人是位olled in a multicenter, observational, and prospectively collected study from 2018 to 2021 at 18 spinal deformity centers in North America were queried. Eligible participants met at least one of the following radiographic and/or procedural inclusion criteria: pelvic incidence minus lumbar lordosis (PI-LL) ≥ 25°, T1 pelvic angle (T1PA) ≥ 30°, sagittal vertical axis (SVA) ≥ 15 cm, thoracic scoliosis ≥ 70°, thoracolumbar scoliosis ≥ 50°, global coronal malalignment ≥ 7 cm, 3-column osteotomy, spinal fusion ≥ 12 levels, and/or age ≥ 65 years with ≥ 7 levels of instrumentation. Patients with an inflammatory or autoimmune disease and those who were incarcerated or pregnant were excluded, as were non-English speakers. Only patients with baseline and 6-week postoperative lower-extremity motor score (LEMS) were analyzed. Patient information, including demographic data, operative data, patient-reported outcomes, and radiographic parameters, were collected. Univariate and multivariable logistic regression models were built to quantify the degree to which a patient’s postoperative LEMS decline was related to demographic and clinical characteristics.

RESULTS

In total, 205 patients (mean age 61.5 years, mean total instrumented levels 12.6, 67.3% female, 54.2% primary cases, 79.5% with pelvic fixation) were evaluated. Of these 205 patients, 32 (15.5%) experienced LEMS decline in the perioperative period. These patients were older (p = 0.0014) and had greater BMI (p = 0.0176), higher frailty scores (p = 0.047), longer operating room times (p = 0.033), and greater estimated blood loss (p < 0.0001), and they were more frequently observed to have intraoperative neurophysiological monitoring (IONM) changes (p = 0.018). The deteriorated cohort had greater C7SVA at baseline (p = 0.0028) but were comparable in terms of all other radiographic parameters. No radiographic differences were seen between the groups at the 6-week visit; however, the deteriorated cohort experienced greater change in PI-LL (p < 0.0001), lumbar lordosis (p = 0.0461), C7SVA (p = 0.0004), and T1PA (p < 0.0001). Multivariate logistic regression demonstrated that the presence of IONM changes and each degree of negative change in T1PA conferred 3.71 (95% CI 1.01–13.42) and 1.09 (1.01–1.19) greater odds of postoperative LEMS deterioration, respectively.

CONCLUSIONS

In this study, 15.6% of ASD patients incurred LEMS decline in the perioperative period. The magnitude of change in global sagittal alignment, specifically T1PA, was the strongest independent predictor of LEMS decline, which has implications for surgical planning, patient counseling, and clinical research.

ABBREVIATIONS

ASD = adult spinal deformity ; ASF = anterior spinal fusion ; 亚洲=美国脊髓损伤学会 ; IONM = intraoperative neurophysiological monitoring ; LEMS = lower-extremity motor score ; LIV = lower instrumented vertebrae ; LL = lumbar lordosis ; NRS = numeric rating scale ; ODI = Oswestry Disability Index ; OR = operating room ; PCO = posterior column osteotomy ; PI-LL = pelvic incidence minus lumbar lordosis ; PRO = patient-reported outcome ; PROMIS = Patient-Reported Outcomes Measurement Information System ; PSF = posterior spinal fusion ; PSO = pedicle subtraction osteotomy ; SRS = Scoliosis Research Society ; SSEP = somatosensory evoked potential ; SVA = sagittal vertical axis ; tcMEP = transcranial motor evoked potential ; TIL = total instrumented level ; T1PA = T1 pelvic angle ; UIV = upper instrumented vertebrae ; VCR = vertebral column resection ; VR12 = Veterans RAND 12-Item Health Survey .

Supplementary Materials

    • Supplemental Tables 1-3 (PDF 533 KB)
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Cover Journal of Neurosurgery: Spine

Volume 39: Issue 2 (Aug 2023)

inJournal of Neurosurgery: Spine
Figure from Yu et al. (pp 238–246).
Volume 39: Issue 2

Contributor Notes

CorrespondenceFthimnir M. Hassan: The Daniel and Jane Och Spine Hospital, NewYork-Presbyterian, Columbia University Medical Center, New York, NY.fh2444@cumc.columbia.edu.

INCLUDE WHEN CITINGPublished online April 28, 2023; DOI: 10.3171/2023.3.SPINE221311.

Disclosures从美敦力公司Lenke博士报道顾问费用,consultant fees from Abryx, consultant fees from EOS Technology, and grants from AO Spine outside the submitted work. Dr. Burton reported personal fees from DePuy Spine, personal fees from Globus, personal fees from Blue Ocean Spine, and stock options from Progenerative Medial and served on the board of directors of the International Spine Study Group and Scoliosis Research Society during the conduct of the study. Dr. Daniels reported grants from Stryker, personal fees from Stryker, personal fees from Orthofix, personal fees from Medtronic, grants from Medtronic, and personal fees from Spineart outside the submitted work. Dr. Gupta reported grants from ISSGF during the conduct of the study, personal fees from DePuy, non-financial support from DePuy, personal fees from Medtronic, non-financial support from Medtronic, non-financial support from the Scoliosis Research Society, non-financial support from Zimmer, personal fees from AO Spine, personal fees from LSU Grand Rounds, personal fees from Wright State Grand Rounds, stock from J&J, personal fees from Globus, non-financial support from Globus, voluntary and non-financial relationship with the National Health Spine Foundation Scientific Advisory Board, and non-financial support from AO Spine outside the submitted work. Dr. Kebaish reported royalties from DePuy Synthes, royalties from Stryker, royalties from Orthofix, royalties from SpineCraft, and personal consulting fees from Ethicon outside the submitted work. Dr. Kim reported grants from ISSGF, personal fees from Zimmer Biomet, personal fees from K2M/Stryker, personal fees from Acuity Surgical, personal fees from NuVasive, and personal fees from Aspen Medical outside the submitted work. Dr. Klineberg reported personal consulting fees from DePuy Synthes, personal consulting fees from Stryker, personal consulting fees from Medtronic, personal consulting fees from SeaSpine, personal consulting fees from SI Bone, personal consulting fees from Agnovos, stock from MMI, stock from Relatable, fellowship grants from AO Spine, and personal honoraria fees from AO Spine and serves as chair elect of IMAST and as chair elect and fellowship chair of AO Spine and outside the submitted work. Dr. Passias reported personal consultant fees from Medtronic, personal consultant fees from Globus, and personal consultant fees from Royal Biologics outside the submitted work. Dr. Protopsaltis reported personal consulting fees from Globus, personal consulting fees from NuVasive, personal consulting fees from Medtronic, personal consulting fees from Stryker K2M, royalties from Altus, grants from Medtronic paid to an institution, and stock from OnePoint Surgical outside the submitted work. Dr. Schwab reported personal consulting fees and royalties from Zimmer Biomet, personal consulting fees from Mainstay Medical, personal consulting fees from Medtronic, and personal royalty fees from Stryker Corp., serves on the executive committee of the International Spine Study Group, owns stock in VFT Solutions, and owns stock in SeaSpine outside the submitted work. Dr. Shaffrey reported other from ISSG Foundation and Duke University during the conduct of the study, personal fees from NuVasive, personal fees from Medtronic, personal fees from SI Bone, and personal fees from Proprio outside the submitted work. Dr. Smith reported grants from AO Spine during the conduct of the study; and personal fees from Cerapedics, personal fees from Carlsmed, personal fees from SeaSpine, personal fees from ZimVie, personal fees from NuVasive, grants from NuVasive, grants from AO Spine, personal stock ownership in Alphatec, and personal stock ownership in NuVasive outside the submitted work. Mr. Line reported personal fees from International Spine Study Group outside the submitted work. Dr. V. Lafage reported grants from the International Spine Study Group during the conduct of the study; and personal consulting fees from Alphatec, personal consulting fees from Globus Medical, personal royalties from NuVasive, personal fees for lectures from Johnson and Johnson, personal fees for lectures from Stryker, non-financial support from ISSG as an executive committee member, and non-financial support from SRS as a committee member outside the submitted work. Dr. Bess reported grants from Medtronic, grants from Globus, grants from NuVasive, grants from Stryker, grants from Carlsmed, grants from ISSGF, and grants from SI bone during the conduct of the study; and grants from DePuy Synthes, personal fees from Atec, and grants from SeaSpine outside the submitted work.
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