title: Incidence and the risk factors of spinal deformity in adult patient after spinal cord injury: a single center cohort study.
abstract: METHODS
  A retrospective consecutive case series of adult spinal cord injuries (SCIs) patients.
  
  
  OBJECTIVE
  To assess the incidence and risk factors of spinal deformity in a large sample of patients with SCIs. Post-traumatic spinal deformities are well-recognized sequelae of SCIs. Despite the devastating complications for SCI patients with trunk imbalance, the incidence, clinical outcomes, and independent risk factors of scoliosis after SCI remain controversial.
  
  
  METHODS
  We assessed 214 consecutive adult compressive SCI patients who were hospitalized in our hospital. We compared patients who developed spinal deformities with those who did not. Univariate and multivariate analyses to determine the independent risk factors were performed. Age, gender, etiology, ASIA grade (American Spinal Injury Association) surgery, and other demographic data were analyzed to determine the risk factors for developing a spinal deformity.
  
  
  RESULTS
  The average patient age was 58.3 years (20-86 years). The etiology was trauma (n = 158), ossification of ligament (n = 22), infectious (n = 17), and others. One hundred fifty-two patients had cervical spine involved, 62 had thoracic spine involved. 26 patients classified as ASIA A, 54 were ASIA B, 96 were ASIA C, and 42 were ASIA D 4. One hundred thirty-five patients had either decompression or decompression and fusion surgery. The incidence of spinal deformities was 21 % (44/214). The mean Cobb angle was 28.9 degrees (13-38°). ASIA grade and surgery predicted the occurrence of spinal deformity in both the univariate model (ASIA grade, OR: 1.59 [95 % CI: 1.04-2.44; P = 0.032]; Surgery, OR: 4.47 [95 % CI: 1.89-10.06; P = 0.0007]) and the multivariate model (ASIA grade, OR: 1.63 [95 % CI: 1.04-2.57; P = 0.033]; Surgery, OR: 4.59 [95 % CI: 1.91-11.04; P = 0.0006]), whereas surgery was the most important risk factor in the Cox model (HR: 3.50 [95 % CI: 1.56-7.88; P = 0.0025]).
  
  
  CONCLUSIONS
  The SCI patients with high ASIA grades and those who had undergone surgery had a higher likelihood of developing a spinal deformity. Of these risk factors, surgery was the stronger risk factor.
authors.affiliation: Department of Orthopedic Surgery, National Center for Musculoskeletal Disorders Murayama Medical Center, 2-37-1 Gakuen, Musashi-Murayama City, Tokyo, Japan, yagiman@gmail.com.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Yagi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hasegawa
authors.forename: Masakazu
authors.initials: M
authors.lastname: Takemitsu
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Yato
authors.forename: Masafumi
authors.initials: M
authors.lastname: Machida
authors.forename: Takashi
authors.initials: T
authors.lastname: Asazuma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000209:etiology*; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D013119:Spinal Cord Injuries / Q000145:classification / Q000150:complications* / Q000601:surgery; D013123:Spinal Fusion; D055815:Young Adult