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Prognostic Factors of Neurological Complications in Spinal Surgeries

STUDY DESIGN: Retrospective study. PURPOSE: To determine prognostic factors of neurological complications (NCs) of posterior thoracolumbar surgeries. OVERVIEW OF LITERATURE: There have been few reports on the prognosis of NCs according to the causes and treatment methods. METHODS: The subjects were...

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Autores principales: Shin, Won Shik, Ahn, Dong Ki, Lee, Jung Soo, Koo, Ki Hyuk, Yoo, In Seon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Spine Surgery 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6068409/
https://www.ncbi.nlm.nih.gov/pubmed/30060384
http://dx.doi.org/10.31616/asj.2018.12.4.734
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author Shin, Won Shik
Ahn, Dong Ki
Lee, Jung Soo
Koo, Ki Hyuk
Yoo, In Seon
author_facet Shin, Won Shik
Ahn, Dong Ki
Lee, Jung Soo
Koo, Ki Hyuk
Yoo, In Seon
author_sort Shin, Won Shik
collection PubMed
description STUDY DESIGN: Retrospective study. PURPOSE: To determine prognostic factors of neurological complications (NCs) of posterior thoracolumbar surgeries. OVERVIEW OF LITERATURE: There have been few reports on the prognosis of NCs according to the causes and treatment methods. METHODS: The subjects were 65 patients who had NCs for 19 years (1995–2013) after posterior thoracolumbar surgeries in Seoul Sacred Heart General Hospital. The degree of neurological injury was assessed using numeric scales as follows: G1, increased leg pain or sensory loss; G2, hemiparesis; G3, paraparesis; G4, cauda equine syndrome; and G5, complete paraplegia. The relative degree of neurological recovery was evaluated using four numeric scales as follows: Gr1, complete recovery; Gr2, almost complete recovery with residual sensory loss or numbness; Gr3, partial recovery with apparent neurological deficit; and Gr4, no recovery. The prognostic factors were investigated in terms of demographic and surgical variables that were available in a retrospective review. RESULTS: The causes were as follows: epidural hematoma (EH), 25 patients (38.5%); insufficient decompression and fusion, 14 patients (21.5%); mechanical injury, 11 patients (16.9%); insufficient discectomy, four patients (6.2%); and unknown, 11 patients (23.1%). The grade of neurological injury was as follows: G1, 11 patients (16.9%); G2, 34 patients (52.3%); G3, 15 patients (23.1%); G4, three patients (4.6%); and G5, two patients (3.1%). Thirteen patients received conservative treatment, and 52 underwent revision surgeries. Neurological recovery was as follows: Gr1, 21 patients (32.3%); Gr2, 17 patients (26.2%); Gr3, 20 patients (30.8%); and Gr4, seven patients (10.8%). The prognosis depended on the causes (p =0.041). The subgroup analysis of the revision group revealed a significant correlation between the degree of neurological recovery and the timing of revision, irrespective of causes (r =0.413, p =0.002). CONCLUSIONS: The prognosis of NC depended on the causes. EH was the best and unknown was the worst prognostic factor. Revision should be performed as soon as possible for a better prognosis.
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spelling pubmed-60684092018-08-08 Prognostic Factors of Neurological Complications in Spinal Surgeries Shin, Won Shik Ahn, Dong Ki Lee, Jung Soo Koo, Ki Hyuk Yoo, In Seon Asian Spine J Clinical Study STUDY DESIGN: Retrospective study. PURPOSE: To determine prognostic factors of neurological complications (NCs) of posterior thoracolumbar surgeries. OVERVIEW OF LITERATURE: There have been few reports on the prognosis of NCs according to the causes and treatment methods. METHODS: The subjects were 65 patients who had NCs for 19 years (1995–2013) after posterior thoracolumbar surgeries in Seoul Sacred Heart General Hospital. The degree of neurological injury was assessed using numeric scales as follows: G1, increased leg pain or sensory loss; G2, hemiparesis; G3, paraparesis; G4, cauda equine syndrome; and G5, complete paraplegia. The relative degree of neurological recovery was evaluated using four numeric scales as follows: Gr1, complete recovery; Gr2, almost complete recovery with residual sensory loss or numbness; Gr3, partial recovery with apparent neurological deficit; and Gr4, no recovery. The prognostic factors were investigated in terms of demographic and surgical variables that were available in a retrospective review. RESULTS: The causes were as follows: epidural hematoma (EH), 25 patients (38.5%); insufficient decompression and fusion, 14 patients (21.5%); mechanical injury, 11 patients (16.9%); insufficient discectomy, four patients (6.2%); and unknown, 11 patients (23.1%). The grade of neurological injury was as follows: G1, 11 patients (16.9%); G2, 34 patients (52.3%); G3, 15 patients (23.1%); G4, three patients (4.6%); and G5, two patients (3.1%). Thirteen patients received conservative treatment, and 52 underwent revision surgeries. Neurological recovery was as follows: Gr1, 21 patients (32.3%); Gr2, 17 patients (26.2%); Gr3, 20 patients (30.8%); and Gr4, seven patients (10.8%). The prognosis depended on the causes (p =0.041). The subgroup analysis of the revision group revealed a significant correlation between the degree of neurological recovery and the timing of revision, irrespective of causes (r =0.413, p =0.002). CONCLUSIONS: The prognosis of NC depended on the causes. EH was the best and unknown was the worst prognostic factor. Revision should be performed as soon as possible for a better prognosis. Korean Society of Spine Surgery 2018-08 2018-07-27 /pmc/articles/PMC6068409/ /pubmed/30060384 http://dx.doi.org/10.31616/asj.2018.12.4.734 Text en Copyright © 2018 by Korean Society of Spine Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Shin, Won Shik
Ahn, Dong Ki
Lee, Jung Soo
Koo, Ki Hyuk
Yoo, In Seon
Prognostic Factors of Neurological Complications in Spinal Surgeries
title Prognostic Factors of Neurological Complications in Spinal Surgeries
title_full Prognostic Factors of Neurological Complications in Spinal Surgeries
title_fullStr Prognostic Factors of Neurological Complications in Spinal Surgeries
title_full_unstemmed Prognostic Factors of Neurological Complications in Spinal Surgeries
title_short Prognostic Factors of Neurological Complications in Spinal Surgeries
title_sort prognostic factors of neurological complications in spinal surgeries
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6068409/
https://www.ncbi.nlm.nih.gov/pubmed/30060384
http://dx.doi.org/10.31616/asj.2018.12.4.734
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