Man Yam Wa, Lui Jedidiah Yui Shing, Lam Chor Yin, Cheung Jason Pui Yin, Cheung Prudence Wing Hang
Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China.
Neurospine. 2025 Mar;22(1):243-263. doi: 10.14245/ns.2449364.682. Epub 2025 Mar 31.
To investigate the incidence of postoperative neurological complications among patients who underwent spinal deformity surgery and to determine the significant risk factors for postoperative neurological complications.
Six databases PubMed, Web of Science, Scopus, MEDLINE, Embase, and Cochrane Library have been searched to identify observational studies from inception until January 2025. Inclusion criteria were patients aged ≥10 years with postoperative neurological complications after spinal deformity surgery. Stata/MP18.0 was used to conduct the meta-analysis in this review. The summary incidence estimates, proportion with 95% confidence intervals (CIs) and weights were pooled by the random-effects restricted maximum likelihood model.
The search strategy identified 53 articles with 40,958 patients for final review. Overall incidence of postoperative neurological complications was 7% (95% CI, 5.0%-9.0%; p < 0.001; I2 = 98.34%) in which incidence estimates for patients with adult spinal deformity and underwent 3-column spinal osteotomies were 12% (95% CI, 9%-16%; p < 0.001; I2 = 93.17%) and 18% (95% CI, 8%-31%; p < 0.001; I2 = 94.68%) respectively. Preoperative neurological deficit was the risk factor with highest overall odds ratio (OR, 2.86; 95% CI, 1.85-4.41; p = 0.01; I2 = 76.20%), followed by the presence of kyphosis (OR, 1.13; 95% CI, 0.75-1.70; p = 0.02; I2 = 81.80%) and age at surgery (OR, 1.04; 95% CI, 1.01-1.08; p = 0.04; I2 = 68.80%).
Preoperative neurological deficit, the presence of kyphosis and age at surgery were significant risk factors for postoperative neurological complications. Therefore, comprehensive preoperative assessment and surgical planning are crucial to minimize the risk of developing postoperative neurological complications or the deterioration of pre-existing neurologic deficits.
调查接受脊柱畸形手术患者术后神经并发症的发生率，并确定术后神经并发症的显著危险因素。
检索了六个数据库，即PubMed、Web of Science、Scopus、MEDLINE、Embase和Cochrane图书馆，以识别从开始到2025年1月的观察性研究。纳入标准为年龄≥10岁且脊柱畸形手术后出现术后神经并发症的患者。本综述使用Stata/MP18.0进行荟萃分析。汇总发病率估计值、95%置信区间（CI）的比例和权重通过随机效应限制最大似然模型进行合并。
检索策略确定了53篇文章，共40958例患者进行最终审查。术后神经并发症的总体发生率为7%（95%CI，5.0%-9.0%；p<0.001；I2=98.34%），其中成人脊柱畸形患者和接受三柱脊柱截骨术患者的发生率估计分别为12%（95%CI，9%-16%；p<0.001；I2=93.17%）和18%（95%CI，8%-31%；p<0.001；I2=94.68%）。术前神经功能缺损是总体比值比最高的危险因素（OR，2.86；95%CI，1.85-4.41；p=0.01；I2=76.20%），其次是后凸畸形的存在（OR，1.13；95%CI，0.75-1.70；p=0.02；I2=81.80%）和手术年龄（OR，1.04；95%CI，1.01-1.08；p=0.04；I2=68.80%）。
术前神经功能缺损、后凸畸形的存在和手术年龄是术后神经并发症的显著危险因素。因此，全面的术前评估和手术规划对于将术后神经并发症的发生风险或既往神经功能缺损的恶化风险降至最低至关重要。
