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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?
- Source :
- The Spine Journal. 19:395-402
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- BACKGROUND 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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Population
Context (language use)
Walking
Scoliosis
Neurosurgical Procedures
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Interquartile range
medicine
Humans
Orthopedics and Sports Medicine
education
Prospective cohort study
Aged
030222 orthopedics
education.field_of_study
business.industry
Middle Aged
medicine.disease
Spine
Surgery
Lower Extremity
Cohort
Female
Neurology (clinical)
Complication
business
030217 neurology & neurosurgery
Cohort study
Subjects
Details
- ISSN :
- 15299430
- Volume :
- 19
- Database :
- OpenAIRE
- Journal :
- The Spine Journal
- Accession number :
- edsair.doi.dedup.....5266cd45d4dbf938a86d5df2555e487b