Analysis of risk factors and treatment outcome in patients presenting with neglected congenital spinal deformity and neurological deficit

OBJECTIVEThe authors evaluated the neurological outcomes of adult spinal deformity patients after 3-column osteotomy (3CO), including severity and long-term improvement of neurological complications, as well as risk factors for neurological deficit at 1 year postoperatively. Although 3CO is effective for correcting rigid spinal deformity, it is associated with a high complication rate. Neurological deficits, in particular, cause disability and dissatisfaction.METHODSThe authors retrospectively queried a prospective database of adult spinal deformity patients who underwent vertebral column resection or pedicle subtraction osteotomy between 2004 and 2014 by one surgeon at a tertiary care center. The authors included 199 adults with at least 1-year follow-up. The primary outcome measure was change in lower-extremity motor scores (LEMSs), which were obtained preoperatively, within 2 weeks postoperatively, and at 6 and 12 months postoperatively. To identify risk factors for persistent neurological deficit, the authors compared patient and surgical characteristics with a declined LEMS at 12-month follow-up (n = 10) versus those with an improved/maintained LEMS at 12-month follow-up (n = 189).RESULTSAt the first postoperative assessment, the LEMS had improved in 15% and declined in 10% of patients compared with preoperative scores. At the 6-month follow-up, 6% of patients continued to have a decline in LEMS, and 16% had improvement. At 12 months, LEMS had improved in 17% and declined in 5% of patients compared with preoperative scores. The only factor significantly associated with a decline in 12-month LEMS was high-grade spondylolisthesis as an indication for surgery (OR 13, 95% CI 3.2–56).CONCLUSIONSAlthough the LEMS declined in 10% of patients immediately after 3CO, at 12 months postoperatively, only 5% of patients had neurological motor deficits. A surgical indication of high-grade spondylolisthesis was the only factor associated with neurological deficit at 12 months postoperatively.

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Indications and practice of enteral nutrition

Orvosi Hetilap ◽

10.1556/oh.2014.30066 ◽

2014 ◽

Vol 155 (51) ◽

pp. 2028-2033 ◽

Cited By ~ 1

Author(s):

Judit Hallay ◽

Dániel Nagy ◽

Béla Fülesdi

Keyword(s):

Risk Factors ◽

Treatment Outcome ◽

Enteral Nutrition ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Nutrition Therapy ◽

Present Review ◽

Hospitalised Patients ◽

Impact On Treatment ◽

Efficacy Of Treatment

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patient’s condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy. Orv. Hetil., 2014, 155(51), 2028–2033.

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Recurrence of proximal junctional kyphosis after revision surgery for symptomatic proximal junctional kyphosis in patients with adult spinal deformity: incidence, risk factors, and outcomes

European Spine Journal ◽

10.1007/s00586-020-06669-0 ◽

2021 ◽

Author(s):

Haruki Funao ◽

Floreana N. Kebaish ◽

Richard L. Skolasky ◽

Khaled M. Kebaish

Keyword(s):

Risk Factors ◽

Spinal Deformity ◽

Revision Surgery ◽

Adult Spinal Deformity ◽

Proximal Junctional Kyphosis ◽

Incidence Risk ◽

Junctional Kyphosis

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Failure Types and Related Factors of Spinopelvic Fixation After Long Construct Fusion for Adult Spinal Deformity

Neurosurgery ◽

10.1093/neuros/nyaa469 ◽

2020 ◽

Author(s):

Se-Jun Park ◽

Jin-Sung Park ◽

Yunjin Nam ◽

Tae-Hoon Yum ◽

Youn-Taek Choi ◽

...

Keyword(s):

Risk Factors ◽

Ct Scan ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Study Cohort ◽

Related Factors ◽

Fixation Failure ◽

Failure Group ◽

Pelvic Fixation ◽

Spinopelvic Fixation

Abstract BACKGROUND Rigid internal fixation of the spine is an essential part of adult spinal deformity (ASD) surgery. Despite the use of pelvic fixation and anterior column support, spinopelvic fixation failure (SPFF) still remains an issue. Few studies have evaluated the types of such failure or its related factors. OBJECTIVE To classify the types of SPFF and investigate its risk factors, including the fusion status at L5-S1 on CT scan. METHODS The study cohort consisted of ninety-eight ASD patients who underwent more than 4-level fusions to the sacrum with interbody fusion at L5-S1. Patients with SPFF were divided into the two groups: above-S1 and below-S1 failure groups. The patient, surgical, and radiographic variables in each group were compared to those of the no-failure group. The L5-S1 fusion status was assessed using 2-yr computed tomography (CT) scan. Univariate and multivariate analyses were performed to determine the risk factors for each failure group. RESULTS The mean age was 68.5 yr. Follow-up duration was 55.7 mo. The SPFF developed in 46 (46.9%) patients at 32.7 mo postoperatively. There were 15 patients in the above-S1 failure group and 31 patients in the below-S1 failure group. Multivariate analysis revealed that nonunion at L5-S1 was a single risk factor for above-S1 failure. In contrast, the risk factors for below-S1 failure included a greater number of fused segments and postoperative less thoracic kyphosis. CONCLUSION SPFF develops in different patterns with different risk factors. Above-S1 SPFF was associated with nonunion at L5-S1, while below-S1 SPFF was associated with mechanical stress.

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Risk factors of unplanned neurosurgery for scoliotic patients with Chiari malformation type I and syringomyelia after spinal deformity correction

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2020.106014 ◽

2020 ◽

Vol 196 ◽

pp. 106014

Author(s):

Ming Luo ◽

Diuwei Wu ◽

Xuanhe You ◽

Zhipeng Deng ◽

Tingting Xiao ◽

...

Keyword(s):

Risk Factors ◽

Spinal Deformity ◽

Chiari Malformation ◽

Deformity Correction ◽

Type I ◽

Chiari Malformation Type I

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Risk Factors Associated with Surgical Site Infection in Pediatric Patients Undergoing Spinal Deformity Surgery

JBJS Reviews ◽

10.2106/jbjs.rvw.19.00163 ◽

2020 ◽

Vol 8 (3) ◽

pp. e0163

Author(s):

Hiroko Matsumoto ◽

Matthew E. Simhon ◽

Megan L. Campbell ◽

Michael G. Vitale ◽

Elaine L. Larson

Keyword(s):

Risk Factors ◽

Surgical Site Infection ◽

Spinal Deformity ◽

Pediatric Patients ◽

Site Infection ◽

Factors Associated ◽

Spinal Deformity Surgery

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Neurological Deficit after Carotid Infusion of Cisplatin and 1,3-Bis(2-chloroethyl)-1-nitrosourea (BCNU) for Malignant Glioma: An Analysis of Risk Factors

Neurosurgery ◽

10.1227/00006123-198611000-00010 ◽

1986 ◽

Vol 19 (5) ◽

pp. 779-783 ◽

Cited By ~ 16

Author(s):

P. Kapp John ◽

A. Sanford Robert

Keyword(s):

Risk Factors ◽

Neurological Deficit ◽

Infusion Pump ◽

Malignant Gliomas ◽

Internal Capsule ◽

Neurological Deficits ◽

Infusion Therapy ◽

Infusion Line ◽

Permanent Neurological Deficit ◽

Infusion Technique

Abstract The records of 24 patients with malignant gliomas treated with carotid infusion of cisplatin and 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) are reviewed for risk factors that might suggest the development of a permanent neurological deficit after infusion. Permanent neurological deficits were seen with doses of cisplatin as low as 69 mg/m2, although doses as high as 100 mg/m2 were tolerated by other patients. All 3 patients who developed permanent neurological deficits received fixed doses of cisplatin of 150 mg and supplied only 2 major intracranial branches from the infused carotid artery. In none of these patients was a filter used in the infusion line. Other risk factors identified in 2 of the 3 patients were diffuse neoplasm involving the region of the internal capsule and the use of an infusion pump rather than a pulsatile bolus infusion technique. The development of a permanent neurological deficit appeared unrelated to the dose of BCNU within the range utilized, and preinfusion administration of corticosteroids did not prevent neurological deficit. These possible risk factors should be considered in the future development of protocols for arterial infusion therapy of malignant gliomas.

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Incidence and Risk Factors for Neurological Deterioration in Posterior Corrective Surgeries for Severe Angular Kyphotic Deformities: A 10-Year Institutional Retrospective Study

Global Spine Journal ◽

10.1177/2192568220979122 ◽

2020 ◽

pp. 219256822097912

Author(s):

Kalyan Kumar Varma Kalidindi ◽

Sulaiman Sath ◽

Jeevan Kumar Sharma ◽

Gayatri Vishwakarma ◽

Harvinder Singh Chhabra

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Neurological Deficit ◽

Operative Time ◽

Deformity Correction ◽

Neurological Deterioration ◽

Kyphotic Deformity ◽

Neurological Deficits ◽

Retrospective Case ◽

Significant Difference

Study Design: Retrospective case-control study. Objective: Neurological deficit is one of the dreaded complications of kyphotic deformity correction procedures. There is inconsistency in the reports of neurological outcomes following such procedures and only a few studies have analyzed the risk factors for neurological deficits. We aimed to analyze the factors associated with neurological deterioration in severe kyphotic deformity correction surgeries. Methods: We performed a retrospective study of 121 consecutive surgically treated severe kyphotic deformity cases (49 males, 56 females) at a single institute (May 1st 2008 to May 31st 2018) and analyzed the risk factors for neurological deterioration. The demographic, surgical and clinical details of the patients were obtained by reviewing the medical records. Results: 105 included patients were divided into 2 groups: Group A (without neurological deficit) with 92 patients (42 males, 50 females) and Group B (with neurological deficit) with 13 patients (7 males, 6 females) (12.4%). Statistically significant difference between the 2 groups was observed in the preoperative sagittal Cobbs angle (p < 0.0001), operative time (p = 0.003) and the presence of myelopathic signs on neurological examination (p = 0.048) and location of the apex of deformity (p = 0.010) but not in other factors. Conclusions: Preoperative Sagittal Cobbs angle, presence of signs of myelopathy, operative time and location of apex in the distal thoracic region were significantly higher in patients with neurological deterioration as compared to those without neurological deterioration during kyphotic deformity correction surgery. Distal thoracic curve was found to have 4 times more risk of neurological deterioration compared to others.

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