Unilateral versus bilateral lower extremity motor deficit following complex adult spinal deformity surgery: is there a difference in recovery up to 2-year follow-up?
BACKGROUND CONTEXT
Scoli-RISK-1 is a multicenter prospective cohort designed to study neurologic outcomes following complex adult spinal deformity (ASD). The effect of unilateral versus bilateral postoperative motor deficits on the likelihood of long-term recovery has not been previously studied in this population.


PURPOSE
To evaluate whether bilateral postoperative neurologic deficits have a worse recovery than unilateral deficits.


STUDY DESIGN
Secondary analysis of a prospective, multicenter, international cohort study.


METHODS
In a cohort of 272 patients, neurologic decline was defined as deterioration of the American Spinal Injury Association Lower Extremity Motor Scores (LEMS) following surgery. Patients with lower extremity neurologic decline were grouped into unilateral and bilateral cohorts. Differences in demographics, surgical variables, and patient outcome measures between the two cohorts were analyzed.


RESULTS
A total of 265 patients had LEMS completed at discharge. Unilateral decline was seen in 32 patients (12%), while 29 (11%) had bilateral symptoms. At 2 years, there was no significant difference in either median LEMS (unilateral 50.0, interquartile range [IQR] 47.5-50.0; bilateral 50.0, IQR 48.0-50.0, p=.939) or change in LEMS from baseline (unilateral 0.0, IQR -1.0 to 0.0; bilateral 0.0, IQR -1.0 to 0.0, p=.920). In both groups, approximately two-thirds of patients saw recovery to at least their preoperative baseline by 2 years postoperatively (unilateral n=15, 63%; bilateral n=14, 67%). The mean Scoliosis Research Society-22R (SRS-22R) score at 2 years was 3.7±0.6 versus 3.2±0.6 (p=.009) for unilateral and bilateral groups, respectively.


CONCLUSIONS
The prognosis for neurologic recovery of new motor deficits following complex adult spinal deformity is similar with both unilateral and bilateral weaknesses. Despite similar rates of neurologic recovery, patient reported outcomes for those with bilateral motor decline measured by SRS-22R are worse at 2 years after surgery.
['Tuchman|Alexander|A|', 'Lenke|Lawrence G|LG|', 'Cerpa|Meghan|M|', 'Fehlings|Michael G|MG|', 'Lewis|Stephen J|SJ|', 'Shaffrey|Christopher I|CI|', 'Cheung|Kenneth M C|KMC|', 'Carreon|Leah Yacat|LY|', 'Dekutoski|Mark B|MB|', 'Schwab|Frank J|FJ|', 'Boachie-Adjei|Oheneba|O|', 'Kebaish|Khaled|K|', 'Ames|Christopher P|CP|', 'Qiu|Yong|Y|', 'Matsuyama|Yukihiro|Y|', 'Dahl|Benny T|BT|', 'Mehdian|Hossein|H|', 'Pellisé|Ferran|F|', 'Berven|Sigurd H|SH|']
D000328:Adult D000368:Aged D005260:Female D006801:Humans D035002:Lower Extremity D008297:Male D008875:Middle Aged D019635:Neurosurgical Procedures D011183:Postoperative Complications D012600:Scoliosis D013131:Spine D016138:Walking
Spinal deformity Surgery Neurologic deficit Scoliosis Complication Spine