A New Multicenter Survey of Neurologic Deficits After Spinal Deformity Surgery: Are New Models of Intraoperative Neurophysiologic Monitoring Less Accurate?

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Abstract

Abstract of Reviewed Article

Rates of New Neurological Deficit Associated With Spine Surgery Based on 108,419 Procedures: A Report of the Scoliosis Research Society Morbidity and Mortality Committee

Abstract of Reviewed Article

Hamilton DK, Smith JS, et al.

Abstract of Reviewed Article

Spine 2011;36:1218–1228

Abstract of Reviewed Article

DOI: 1210.1097/BRS.1210b1013e3181ec1215fd1219.

Abstract of Reviewed Article

Study Design: Retrospective review of a prospectively collected, multicentered database.

Abstract of Reviewed Article

Objective: To assess rates of new neurological deficit (NND) associated with spine surgery.

Abstract of Reviewed Article

Summary of Background Data: NND is a potential complication of spine surgery, but previously reported rates are often limited by small sample size and single-surgeon experiences.

Abstract of Reviewed Article

Methods: The Scoliosis Research Society morbidity and mortality database was queried for spinal surgery cases complicated by NND from 2004–2007, including nerve root deficit (NRD), cauda equina deficit (CED), and spinal cord deficit (SCD). Use of neuromonitoring was assessed. Recovery was stratified as complete, partial, or none. Rates of NND were stratified based on diagnosis, age (pediatric <21; adult ≥21), and surgical parameters.

Abstract of Reviewed Article

Results: Of 108,419 cases reported, NND was documented for 1,064 (1.0%), including 662 NRD, 74 CED, and 293 SCD (deficit not specified for 35 cases). Rates of NND were calculated based on diagnosis. Revision cases had a 41% higher rate of NND (1.25%), compared with primary cases (0.89%; P < 0.001). Pediatric cases had a 59% higher rate of NND (1.32%%) compared with adult cases (0.83%; P < 0.001). The rate of NND for cases with implants was more than twice that for cases without implants (1.15% versus 0.52%, P < 0.001). Neuromonitoring was used for 65% of cases, and for cases with new NRD, CED, and SCD, changes in neuromonitoring were reported in 11%, 8%, and 40%, respectively. The respective percentages of no recovery, partial and complete recovery for NRD were 4.7%, 46.8% and 47.1%; for CED were 9.6%, 45.2% and 45.2%; and for SCD were 10.6%, 43% and 45.7%, respectively.

Abstract of Reviewed Article

Conclusion: Our data demonstrate that, even among skilled spinal deformity surgeons, new neurological deficits are inherent potential complications of spine surgery. These data provide general benchmark rates for NND with spine surgery as a basis for patient counseling and for ongoing efforts to improve safety of care.

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