复杂成人脊柱畸形手术后主要与次要神经功能下降的发生率和结局分析：Scoli-RISK-1 研究的亚分析。
An Analysis of the Incidence and Outcomes of Major Versus Minor Neurological Decline After Complex Adult Spinal Deformity Surgery: A Subanalysis of Scoli-RISK-1 Study.
机构信息
University of Toronto Spine Program and Toronto Western Hospital, Toronto, Ontario, Canada.
Columbia University College of Physicians and Surgeons, New York, NY.
出版信息
Spine (Phila Pa 1976). 2018 Jul 1;43(13):905-912. doi: 10.1097/BRS.0000000000002486.
STUDY DESIGN
A subanalysis from a prospective, multicenter, international cohort study in 15 sites (Scoli-RISK-1).
OBJECTIVE
To report detailed information regarding the severity of neurological decline related to complex adult spine deformity (ASD) surgery and to examine outcomes based on severity.
SUMMARY OF BACKGROUND DATA
Postoperative neurological decline after ASD surgeries can occur due to nerve root(s) or spinal cord dysfunction. The impact of decline and the pattern of recovery may be related to the anatomic location and the severity of the injury.
METHODS
An investigation of 272 prospectively enrolled complex ASD surgical patients with neurological status measured by American Spinal Injury Association Lower Extremity Motor Scores (LEMS) was undertaken. Postoperative neurological decline was categorized into "major" (≥5 points loss) versus "minor" (<5 points loss) deficits. Timing and extent of recovery in LEMS were investigated for each group.
RESULTS
Among the 265 patients with LEMS available at discharge, 61 patients (23%) had neurological decline, with 20 (33%) experiencing major decline. Of note, 90% of the patients with major decline had deficits in three or more myotomes. Full recovery was seen in 24% at 6 weeks and increased to 65% at 6 months. However, 34% continued to experience some neurological decline at 24 months, with 6% demonstrating no improvement. Of 41 patients (67%) with minor decline, 73% had deficits in one or two myotomes. Full recovery was seen in 49% at 6 weeks and increased to 70% at 6 months. Of note, 26% had persistence of some neurological deficit at 24 months, with 18% demonstrating no recovery.
CONCLUSION
In patients undergoing complex ASD correction, a rate of postoperative neurological decline of 23% was noted with 33% of these being "major." Although most patients showed substantial recovery by 6 months, approximately one-third continued to experience neurological dysfunction.
LEVEL OF EVIDENCE
研究设计
一项在 15 个地点进行的前瞻性、多中心、国际队列研究（Scoli-RISK-1）的亚分析。
目的
报告与复杂成人脊柱畸形（ASD）手术相关的神经功能下降严重程度的详细信息，并根据严重程度检查结果。
背景资料概要
ASD 手术后出现的术后神经功能下降可能是由于神经根或脊髓功能障碍引起的。下降的影响和恢复模式可能与损伤的解剖位置和严重程度有关。
方法
对 272 例前瞻性纳入的复杂 ASD 手术患者进行了研究，通过美国脊髓损伤协会下肢运动评分（LEMS）测量其神经状态。将术后神经功能下降分为“主要”（损失≥5 分）和“次要”（损失<5 分）缺陷。对每组 LEMS 的恢复时间和程度进行了研究。
结果
在 265 例可获得 LEMS 的出院患者中，61 例（23%）出现神经功能下降，其中 20 例（33%）出现主要下降。值得注意的是，90%的主要下降患者的三个或更多肌节出现缺陷。24 周时 24%的患者完全恢复，6 个月时增加到 65%。然而，34%的患者在 24 个月时仍有一些神经功能下降，6%的患者没有改善。在 41 例（67%）有轻微下降的患者中，73%的患者有一个或两个肌节缺陷。49%的患者在 24 周时完全恢复，6 个月时增加到 70%。值得注意的是，26%的患者在 24 个月时有持续的一些神经缺陷，18%的患者没有恢复。
结论
在接受复杂 ASD 矫正的患者中，术后神经功能下降率为 23%，其中 33%为“主要”下降。尽管大多数患者在 6 个月时表现出明显的恢复，但约三分之一的患者仍持续存在神经功能障碍。
证据等级
2。
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