title: Neurologic Outcomes of Complex Adult Spinal Deformity Surgery: Results of the Prospective, Multicenter Scoli-RISK-1 Study.
abstract: METHODS
  Prospective, multicenter, international observational study.
  
  
  OBJECTIVE
  To evaluate motor neurologic outcomes in patients undergoing surgery for complex adult spinal deformity (ASD).
  
  
  BACKGROUND
  The neurologic outcomes after surgical correction for ASD have been reported with significant variability and have not been measured as a primary endpoint in any prospective, multicenter, observational study.
  
  
  METHODS
  The primary outcome measure was the change in American Spinal Injury Association (ASIA) Lower Extremity Motor Scores (LEMS) obtained preoperatively, and at hospital discharge, 6 weeks and 6 months postoperatively.
  
  
  RESULTS
  A total of 273 patients with complex ASD underwent surgery at 15 sites worldwide. One patient was excluded for lack of preoperative LEMS. The remaining 272 patients were divided into two groups: normal preoperative LEMS (=50) (Preop NML, N = 204, 75%) and abnormal preoperative LEMS (<50) (Preop ABNML, N = 68, 25%). At hospital discharge, 22.18% of patients showed a decline in LEMS compared with 12.78% who showed an improvement. At 6 weeks, there was a significant change compared with discharge: 17.91% patients showed a decline in LEMS and 16.42% showed an improvement. At 6 months, 10.82% patients showed a decline in preoperative LEMS, 20.52% improvement, and 68.66% maintenance. This was a significant change compared with 6 weeks and at discharge.
  
  
  CONCLUSIONS
  Although complex ASD surgery can restore neurologic function in patients with a preoperative neurologic deficit, a significant portion of patients with ASD experienced postoperative decline in LEMS. Measures that can anticipate and reduce the risk of postoperative neurologic complications are warranted.
  
  
  METHODS
  3.
authors: *Columbia University College of Physicians and Surgeons, New York, NY†University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada‡University of Virginia, Charlottesville, VA§The University of Hong Kong, Hong Kong, People's Republic of China¶Norton Leatherman Spine Center, Louisville, KY||The CORE Institute, Sun City West, AZ**Hospital for Special Surgery, New York, NY††The FOCOS Hospital, Pantang West, Republic of Ghana‡‡Johns Hopkins University, Baltimore, MD§§University of California San Francisco, San Francisco, CA¶¶Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China||||Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Prefecture, Japan##Rigshospitalet, National University of Denmark, Copenhagen, Denmark***University Hospital, Queen's Medical Centre, London, UK†††Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors: Lawrence G
authors: LG
authors: Lenke
authors: Michael G
authors: MG
authors: Fehlings
authors: Christopher I
authors: CI
authors: Shaffrey
authors: Kenneth M C
authors: KM
authors: Cheung
authors: Leah
authors: L
authors: Carreon
authors: Mark B
authors: MB
authors: Dekutoski
authors: Frank J
authors: FJ
authors: Schwab
authors: Oheneba
authors: O
authors: Boachie-Adjei
authors: Khaled M
authors: KM
authors: Kebaish
authors: Christopher P
authors: CP
authors: Ames
authors: Yong
authors: Y
authors: Qiu
authors: Yukihiro
authors: Y
authors: Matsuyama
authors: Benny T
authors: BT
authors: Dahl
authors: Hossein
authors: H
authors: Mehdian
authors: Ferran
authors: F
authors: Pellisé-Urquiza
authors: Stephen J
authors: SJ
authors: Lewis
authors: Sigurd H
authors: SH
authors: Berven
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000639:trends*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult