title: Perioperative Neurologic Complications in Adult Spinal Deformity Surgery: Incidence and Risk Factors in 564 Patients.
abstract: METHODS
  Prognostic study-case controlled.
  
  
  OBJECTIVE
  Describe the rate of neurologic complications in adult spinal deformity surgery and describe the effect of these complications on clinical outcomes.
  
  
  BACKGROUND
  The incidence of neurologic complications and the risk factors for neurologic complications have not been reported in a large series of patients with adult spinal deformity (ASD). Existing series include a mixed patient cohort undergoing different types of spine surgery.
  
  
  METHODS
  Patients with ASD undergoing surgery between 2008 and 2014 were analyzed. Patients with neurologic complications were identified; demographics, operative details, and radiographic and clinical outcomes were compared. A subanalysis of those with surgical and nonsurgical (e.g., stroke) neurologic complications was performed. Statistical analysis included t tests or χ tests as appropriate and a multivariate analysis. A P value of less than 0.025 was considered significant.
  
  
  RESULTS
  A total of 564 patients met the inclusion criteria. The average age was 57 years. There were a total of 116 neurologic complications in 99 patients (17.6%). There were 88 surgical procedure-related neurologic complications in 77 patients (13.7%) and 28 nonsurgical neurologic complications in 28 patients (5.0%). The most common complications were radiculopathy (30%), motor deficits (22%), mental status changes (12%), and sensory deficits (12%). Revisions (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.2-2.4) and interbody fusions (OR 2.1, 95% CI 1.4-3.2) were associated with an increased risk of neurologic complications. Decompression and osteotomies (including three-column osteotomies) did not increase the risk of neurologic complications. Patients with neurologic complications were not more likely to sustain other complications; however, they were more likely to undergo another operation during the follow-up period (OR 1.9, 95% CI 1.3-2.8).
  
  
  CONCLUSIONS
  The overall incidence of neurologic complications in ASD surgery was 17.6%. The incidence of surgical neurologic complications was 13.7%. There was a higher risk of neurologic complications in revision cases and in cases in which interbody fusion was required.
  
  
  METHODS
  3.
authors.affiliation: Hospital for Special Surgery, New York NY.
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Hospital for Special Surgery, New York NY.
authors.forename: Sravisht
authors.initials: S
authors.lastname: Iyer
authors.affiliation: Washington University School of Medicine, St. Louis, MO.
authors.forename: Luke P
authors.initials: LP
authors.lastname: Zebala
authors.affiliation: Washington University School of Medicine, St. Louis, MO.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sciubba
authors.affiliation: New York University Center for Musculoskeletal Care, New York, NY.
authors.forename: Themistocles S
authors.initials: TS
authors.lastname: Protopsaltis
authors.affiliation: Washington University School of Medicine, St. Louis, MO.
authors.forename: Munish
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Neuman
authors.affiliation: San Diego Center for Spinal Disorders, La Jolla, CA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Mundis
authors.affiliation: University of California-San Francisco, San Francisco, CA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: University of Virginia Health System, Charlottesville, VA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Oregon Health Sciences University, Portland, OR.
authors.forename: Robert
authors.initials: R
authors.lastname: Hart
authors.affiliation: University of Kansas Hospital, Kansas City, KS.
authors.forename: Douglas
authors.initials: D
authors.lastname: Burton
authors.affiliation: University of California-Davis, Sacramento, CA.
authors.forename: Eric O
authors.initials: EO
authors.lastname: Klineberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D011843:Radiculopathy / Q000453:epidemiology / Q000601:surgery; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult