复杂成人脊柱畸形手术的神经学转归：前瞻性多中心Scoli-RISK-1研究结果
Neurologic Outcomes of Complex Adult Spinal Deformity Surgery: Results of the Prospective, Multicenter Scoli-RISK-1 Study.
作者信息
Lenke Lawrence G, Fehlings Michael G, Shaffrey Christopher I, Cheung Kenneth M C, Carreon Leah, Dekutoski Mark B, Schwab Frank J, Boachie-Adjei Oheneba, Kebaish Khaled M, Ames Christopher P, Qiu Yong, Matsuyama Yukihiro, Dahl Benny T, Mehdian Hossein, Pellisé-Urquiza Ferran, Lewis Stephen J, Berven Sigurd H
机构信息
*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.
出版信息
Spine (Phila Pa 1976). 2016 Feb;41(3):204-12. doi: 10.1097/BRS.0000000000001338.
STUDY DESIGN
Prospective, multicenter, international observational study.
OBJECTIVE
To evaluate motor neurologic outcomes in patients undergoing surgery for complex adult spinal deformity (ASD).
SUMMARY OF BACKGROUND DATA
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.
CONCLUSION
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.
LEVEL OF EVIDENCE
研究设计
前瞻性、多中心、国际观察性研究。
目的
评估接受复杂成人脊柱畸形（ASD）手术患者的运动神经学结局。
背景数据总结
ASD手术矫正后的神经学结局报道存在显著差异，且在任何前瞻性、多中心观察性研究中均未将其作为主要终点进行测量。
方法
主要结局指标为术前、出院时、术后6周和6个月时获得的美国脊髓损伤协会（ASIA）下肢运动评分（LEMS）的变化。
结果
全球15个地点共有273例复杂ASD患者接受了手术。1例患者因术前LEMS缺失被排除。其余272例患者分为两组：术前LEMS正常（=50）（术前正常运动功能组，N = 204，75%）和术前LEMS异常（<50）（术前异常运动功能组，N = 68，25%）。出院时22.18%的患者LEMS下降，而12.78%有所改善。在6周时，与出院时相比有显著变化：17.91%的患者LEMS下降，16.42%有所改善。在6个月时，10.82%的患者术前LEMS下降，20.52%改善，68.66%维持不变。与6周时和出院时相比，这是一个显著变化。
结论
尽管复杂ASD手术可恢复术前存在神经功能缺损患者的神经功能，但相当一部分ASD患者术后LEMS下降。有必要采取措施预测并降低术后神经并发症风险。
证据等级
3级
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