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Article: Unilateral versus bilateral lower extremity motor deficit following complex adult spinal deformity surgery: is there a difference in recovery up to 2-year follow-up?

TitleUnilateral versus bilateral lower extremity motor deficit following complex adult spinal deformity surgery: is there a difference in recovery up to 2-year follow-up?
Authors
KeywordsComplication
Neurologic deficit
Scoliosis
Spinal deformity
Spine
Issue Date2019
PublisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/spinee
Citation
The Spine Journal, 2019, v. 19 n. 3, p. 395-402 How to Cite?
AbstractBACKGROUND CONTEXT Scoli-RISK-1 is a multicenter prospective cohort designed to study neurologic outcomes following complex adult spinal deformity (ASD). The effect of unilateral versus bilateral postoperative motor deficits on the likelihood of long-term recovery has not been previously studied in this population. PURPOSE To evaluate whether bilateral postoperative neurologic deficits have a worse recovery than unilateral deficits. STUDY DESIGN Secondary analysis of a prospective, multicenter, international cohort study. METHODS In a cohort of 272 patients, neurologic decline was defined as deterioration of the American Spinal Injury Association Lower Extremity Motor Scores (LEMS) following surgery. Patients with lower extremity neurologic decline were grouped into unilateral and bilateral cohorts. Differences in demographics, surgical variables, and patient outcome measures between the two cohorts were analyzed. RESULTS A total of 265 patients had LEMS completed at discharge. Unilateral decline was seen in 32 patients (12%), while 29 (11%) had bilateral symptoms. At 2 years, there was no significant difference in either median LEMS (unilateral 50.0, interquartile range [IQR] 47.5–50.0; bilateral 50.0, IQR 48.0–50.0, p=.939) or change in LEMS from baseline (unilateral 0.0, IQR −1.0 to 0.0; bilateral 0.0, IQR −1.0 to 0.0, p=.920). In both groups, approximately two-thirds of patients saw recovery to at least their preoperative baseline by 2 years postoperatively (unilateral n=15, 63%; bilateral n=14, 67%). The mean Scoliosis Research Society-22R (SRS-22R) score at 2 years was 3.7±0.6 versus 3.2±0.6 (p=.009) for unilateral and bilateral groups, respectively. CONCLUSIONS The prognosis for neurologic recovery of new motor deficits following complex adult spinal deformity is similar with both unilateral and bilateral weaknesses. Despite similar rates of neurologic recovery, patient reported outcomes for those with bilateral motor decline measured by SRS-22R are worse at 2 years after surgery.
Persistent Identifierhttp://hdl.handle.net/10722/278944
ISSN
2017 Impact Factor: 3.119
2015 SCImago Journal Rankings: 1.153

 

DC FieldValueLanguage
dc.contributor.authorTuchman, A-
dc.contributor.authorLenke, LG-
dc.contributor.authorCerpa, M-
dc.contributor.authorFehlings, MG-
dc.contributor.authorLewis, SJ-
dc.contributor.authorShaffrey, CI-
dc.contributor.authorCheung, KMC-
dc.contributor.authorCarreon, LY-
dc.contributor.authorDekutoski, MB-
dc.contributor.authorSchwab, FJ-
dc.contributor.authorBoachie-Adjei, O-
dc.contributor.authorKebaish, K-
dc.contributor.authorAmes, CP-
dc.contributor.authorQiu, Y-
dc.contributor.authorMatsuyama, Y-
dc.contributor.authorDahl, BT-
dc.contributor.authorMehdian, H-
dc.contributor.authorPellisé, F-
dc.contributor.authorBerven, SH-
dc.date.accessioned2019-10-21T02:16:48Z-
dc.date.available2019-10-21T02:16:48Z-
dc.date.issued2019-
dc.identifier.citationThe Spine Journal, 2019, v. 19 n. 3, p. 395-402-
dc.identifier.issn1529-9430-
dc.identifier.urihttp://hdl.handle.net/10722/278944-
dc.description.abstractBACKGROUND CONTEXT Scoli-RISK-1 is a multicenter prospective cohort designed to study neurologic outcomes following complex adult spinal deformity (ASD). The effect of unilateral versus bilateral postoperative motor deficits on the likelihood of long-term recovery has not been previously studied in this population. PURPOSE To evaluate whether bilateral postoperative neurologic deficits have a worse recovery than unilateral deficits. STUDY DESIGN Secondary analysis of a prospective, multicenter, international cohort study. METHODS In a cohort of 272 patients, neurologic decline was defined as deterioration of the American Spinal Injury Association Lower Extremity Motor Scores (LEMS) following surgery. Patients with lower extremity neurologic decline were grouped into unilateral and bilateral cohorts. Differences in demographics, surgical variables, and patient outcome measures between the two cohorts were analyzed. RESULTS A total of 265 patients had LEMS completed at discharge. Unilateral decline was seen in 32 patients (12%), while 29 (11%) had bilateral symptoms. At 2 years, there was no significant difference in either median LEMS (unilateral 50.0, interquartile range [IQR] 47.5–50.0; bilateral 50.0, IQR 48.0–50.0, p=.939) or change in LEMS from baseline (unilateral 0.0, IQR −1.0 to 0.0; bilateral 0.0, IQR −1.0 to 0.0, p=.920). In both groups, approximately two-thirds of patients saw recovery to at least their preoperative baseline by 2 years postoperatively (unilateral n=15, 63%; bilateral n=14, 67%). The mean Scoliosis Research Society-22R (SRS-22R) score at 2 years was 3.7±0.6 versus 3.2±0.6 (p=.009) for unilateral and bilateral groups, respectively. CONCLUSIONS The prognosis for neurologic recovery of new motor deficits following complex adult spinal deformity is similar with both unilateral and bilateral weaknesses. Despite similar rates of neurologic recovery, patient reported outcomes for those with bilateral motor decline measured by SRS-22R are worse at 2 years after surgery.-
dc.languageeng-
dc.publisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/spinee-
dc.relation.ispartofThe Spine Journal-
dc.subjectComplication-
dc.subjectNeurologic deficit-
dc.subjectScoliosis-
dc.subjectSpinal deformity-
dc.subjectSpine-
dc.titleUnilateral versus bilateral lower extremity motor deficit following complex adult spinal deformity surgery: is there a difference in recovery up to 2-year follow-up?-
dc.typeArticle-
dc.identifier.emailCheung, KMC: cheungmc@hku.hk-
dc.identifier.authorityCheung, KMC=rp00387-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.spinee.2018.08.003-
dc.identifier.pmid30118851-
dc.identifier.scopuseid_2-s2.0-85055901325-
dc.identifier.hkuros307750-
dc.identifier.volume19-
dc.identifier.issue3-
dc.identifier.spage395-
dc.identifier.epage402-
dc.publisher.placeNetherlands-

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