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Neurologic Deficits Have a Negative Impact on Patient-Related Outcomes in Primary Presentation Adult Symptomatic Lumbar Scoliosis Surgical Treatment at One-Year Follow-up.

Publication ,  Journal Article
Kang, DG; Baldus, C; Glassman, SD; Shaffrey, CI; Lurie, JD; Bridwell, KH
Published in: Spine (Phila Pa 1976)
April 1, 2017

STUDY DESIGN: A retrospective analysis of prospective, multicenter National Institute of Health clinical trial. OBJECTIVE: The aim of this study was to assess the rate of neurologic complications and impact of new neurologic deficits on 1-year postoperative patient-reported outcomes (PROs). SUMMARY OF BACKGROUND DATA: There are limited studies evaluating the impact of new neurologic deficits on PROs following surgery for primary presentation adult lumbar scoliosis. METHODS: Patients were divided into two groups: new postoperative neurological deficit (Def) or no deficit (NoDef). Preoperative and 1-year follow-up PROs were analyzed [Scoliosis Research Society (SRS) Questionnaire, Oswestry Disability Index (ODI), Short Form-12 Physical/Mental Health Composite Scores (PCS/MCS), and back/leg pain Numerical Rating Scale (NRS)]. RESULTS: One hundred forty-one patients: 14 Def (9.9%), 127 NoDef (90.1%). No differences were observed in demographic, radiographic, or PRO data between groups preoperatively. Def group had longer surgical procedures (8.3 vs. 6.9 hours, P = 0.030), greater blood loss (2832 vs. 2606 mL, P = 0.022), and longer hospitalizations (10.6 vs. 7.8 days, P = 0.004). NoDef group reported significant improvement in all PROs from preop to 1-year postoperative. Def group only had improvement in SRS Pain (2.7 preop to 3.4 postop, P = 0.037) and self-image domains (2.7 to 3.6, p = 0.004), and NRS back pain (6.6 to 3.2, P = 0.004) scores with significant worsening of NRS leg pain (4.1 to 6.1, P = 0.045). Group comparisons of 1-year postop PROs found that Def group reported more NRS leg pain (6.1 vs. 1.7, P < 0.001) and worse outcomes than NoDef group for ODI (35.7 vs. 23.1, P = 0.016) and PCS (32.6 vs. 41.9, P = 0.007). CONCLUSION: We found a 9.9% rate of new neurologic deficits following surgery for symptomatic primary presentation adult lumbar scoliosis, much higher than previous studies. Most neurologic deficits improved by 1-year follow-up, but appeared to have a dramatic negative impact on PROs, with increased postoperative leg pain and greater patient-perceived pathology reported in patients experiencing neurological deficits compared with those who did not. LEVEL OF EVIDENCE: 3.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

April 1, 2017

Volume

42

Issue

7

Start / End Page

479 / 489

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Scoliosis
  • Retrospective Studies
  • Prospective Studies
  • Postoperative Complications
  • Orthopedics
  • Nervous System Diseases
  • Middle Aged
  • Male
 

Citation

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Kang, D. G., Baldus, C., Glassman, S. D., Shaffrey, C. I., Lurie, J. D., & Bridwell, K. H. (2017). Neurologic Deficits Have a Negative Impact on Patient-Related Outcomes in Primary Presentation Adult Symptomatic Lumbar Scoliosis Surgical Treatment at One-Year Follow-up. Spine (Phila Pa 1976), 42(7), 479–489. https://doi.org/10.1097/BRS.0000000000001800
Kang, Daniel G., Christine Baldus, Steven D. Glassman, Christopher I. Shaffrey, Jon D. Lurie, and Keith H. Bridwell. “Neurologic Deficits Have a Negative Impact on Patient-Related Outcomes in Primary Presentation Adult Symptomatic Lumbar Scoliosis Surgical Treatment at One-Year Follow-up.Spine (Phila Pa 1976) 42, no. 7 (April 1, 2017): 479–89. https://doi.org/10.1097/BRS.0000000000001800.
Kang DG, Baldus C, Glassman SD, Shaffrey CI, Lurie JD, Bridwell KH. Neurologic Deficits Have a Negative Impact on Patient-Related Outcomes in Primary Presentation Adult Symptomatic Lumbar Scoliosis Surgical Treatment at One-Year Follow-up. Spine (Phila Pa 1976). 2017 Apr 1;42(7):479–89.
Kang, Daniel G., et al. “Neurologic Deficits Have a Negative Impact on Patient-Related Outcomes in Primary Presentation Adult Symptomatic Lumbar Scoliosis Surgical Treatment at One-Year Follow-up.Spine (Phila Pa 1976), vol. 42, no. 7, Apr. 2017, pp. 479–89. Pubmed, doi:10.1097/BRS.0000000000001800.
Kang DG, Baldus C, Glassman SD, Shaffrey CI, Lurie JD, Bridwell KH. Neurologic Deficits Have a Negative Impact on Patient-Related Outcomes in Primary Presentation Adult Symptomatic Lumbar Scoliosis Surgical Treatment at One-Year Follow-up. Spine (Phila Pa 1976). 2017 Apr 1;42(7):479–489.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

April 1, 2017

Volume

42

Issue

7

Start / End Page

479 / 489

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Scoliosis
  • Retrospective Studies
  • Prospective Studies
  • Postoperative Complications
  • Orthopedics
  • Nervous System Diseases
  • Middle Aged
  • Male