Neurologic Complications in Spinal Deformity Surgery
Evaluation of Neurologic Complications Associated With Surgical Correction of Adult Spinal Deformity: A Prospective, Observational, Multi-center Study
240 subjects with "high risk" adult spinal deformity requiring surgical correction will be enrolled in a prospective multi-center international study. "High risk" patients are defined by either their diagnoses and/or the type of surgical intervention as listed in the inclusion criteria. Neurologic complications in the form of new motor and sensory deficits will be monitored prospectively in all patients at hospital discharge, and at 6 weeks (± 2 weeks) six months (± 2 months) and 24 months(± 2 months) after the surgery. All new deficits will be adjudicated for relationship to the surgical intervention.
Regression analyses will be used to evaluate the association between patient demographics, co morbidities, treatment history, spinal deformity characteristics, surgical characteristics, non-neurologic complications and pre-surgical status to occurrence of a neurologic deficit after surgery.
Studieoversigt
Status
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
Although the incidence of complications in patients undergoing correction of their spinal deformity has been reported extensively, the majority of these studies were retrospective. There were only five studies, three from a single institution, with prospectively collected data that specifically identified complications. The largest series was from Buchowski et al who reported on 108 patients with fixed sagittal deformity undergoing Pedicle Subtraction Osteotomy (PSO) with a 14% over-all complication rate with motor weakness in 11 patients and neurogenic bladder in one patient, of which 3 were permanent. Yang reported on 35 patients undergoing PSOs with a 46% over-all complication rate and one transient nerve root motor deficit. Ahn in 2002 reported on 83 patients undergoing various osteotomies for sagittal imbalance and reported a 34% over-all complication rate with 3 permanent and 3 transient nerve root deficits.
Given this lack of information, there is a need to determine the true incidence of complications using a prospective multi-center design. There is a need to identify neurologic deficits in a more systematic fashion to include spinal cord, cauda equina and nerve root deficits as well as radiculopathies. The risk factors associated with the occurrence of a complication, especially a neurologic complication, also needs to be more fully elucidated. This is increasingly relevant, as newer surgical techniques allow for more aggressive correction of the spinal deformity that may put the spinal cord and nerve roots at increased risk. Valid data on the incidence and types of neurologic deficits is also needed in order to study newer drugs that are available that may mitigate this risk.
The primary objectives of this study are: (i) to establish the incidence of neurologic deficit in "high risk" adult patients undergoing correction of their spinal deformity of adult spinal deformity and (ii) to identify characteristics associated with increased risk of neurologic complications. Secondary objectives include (i) to determine the incidence of all complications related to surgical correction of "high risk" adult spinal deformity; (ii) to determine the short-term clinical outcomes in patients undergoing correction of their spinal deformity and (iii).to determine amount of radiographic and clinical correction of deformity
Undersøgelsestype
Tilmelding (Faktiske)
Kontakter og lokationer
Studiesteder
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Toronto, Canada, M5T 2S8
- University of Toronto
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Copenhagen, Danmark, 2100
- Rigshospitalet
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Nottingham, Det Forenede Kongerige, NG7 2UH
- University Hospital Nottingham, NHS Trust
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California
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San Francisco, California, Forenede Stater, 94118
- University of California
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Kentucky
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Louisville, Kentucky, Forenede Stater, 40202
- Norton Leatherman Spine Center
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Maryland
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Baltimore, Maryland, Forenede Stater, 21205
- Johns Hopkins University
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Minnesota
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Rochester, Minnesota, Forenede Stater, 55905
- Mayo Clinic
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Missouri
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Saint Louis, Missouri, Forenede Stater, 63110
- Department of Orthopaedic Surgery, Washington University School of Medicine
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New York
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New York, New York, Forenede Stater, 10021
- Hospital for Special Surgery
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Yew York, New York, Forenede Stater, 10023
- NYU School of Medicine
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Virginia
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Charlottesville, Virginia, Forenede Stater, 22903
- University of Virginia
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Hamamatsu, Japan, 3192
- University School of Medicine
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Hong Kong, Kina, 102
- University of Hong Kong
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NanJing, Kina, 210008
- Nanjing Drum Tower Hospital
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Barcelona, Spanien, 08035
- Hospital Universitari Vall D'Hebron
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Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Prøveudtagningsmetode
Studiebefolkning
Beskrivelse
Inclusion Criteria:
- Signed informed consent
- Age 18 to 80 years old inclusive
Diagnosis of adult spinal deformity with an apex of the major deformity in the cervico-thoracic or thoraco-lumbar region (Apex between C7 and L2 inclusive) with any of the following deformity characteristics
- Primary Scoliosis, Kyphosis or Kyphoscoliosis with major Cobb ≥ 80° in the coronal or sagittal plane
- Congenital Spinal Deformity undergoing corrective spinal osteotomy
- Revision Spinal Deformity undergoing corrective spinal osteotomy
- Any patient undergoing a 3-column spinal osteotomy (i.e. Pedicle Subtraction Osteotomy, Vertebral Column Resection) from C7 to L5 inclusive
- Any patient with preoperative myelopathy due to their spinal deformity
- Any patient with ossification of the Ligamentum Flavum or Posterior Longitudinal Ligament and a deformity that needs concomitant reconstruction along with decompression of the spinal cord
Exclusion Criteria:
- Unlikely to comply with follow-up
- Recent history ≤ 3 months of substance dependency or psychosocial disturbance
- Presence of active malignancy
- Has active, overt bacterial infection, systemic or local
- Recent (≤3 months) history of significant spinal trauma/injury/ fracture/malignancy in the spinal region
- Patients with complete, long term paraplegia
- Pregnant or nursing women, unable to agree not to become pregnant for a period of 6 months after surgery
- Prisoners
- Institutionalized individuals
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
Kohorter og interventioner
Gruppe / kohorte |
Intervention / Behandling |
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Surgical treatment
This observational study is examining the outcomes of standard surgical treatments for adult spinal deformity.
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Routinely performed surgical correction of spinal deformity
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Rate of treatment-related neurologic complication
Tidsramme: 6 months
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6 months
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Sekundære resultatmål
Resultatmål |
Tidsramme |
|---|---|
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• Sensory status as measured by the ASIA Sensory Score
Tidsramme: 6 months
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6 months
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Samarbejdspartnere og efterforskere
Sponsor
Samarbejdspartnere
Efterforskere
- Ledende efterforsker: Lawrence Lenke, MD, Scoliosis Research Society
Publikationer og nyttige links
Hjælpsomme links
Datoer for undersøgelser
Studer store datoer
Studiestart
Primær færdiggørelse (Faktiske)
Studieafslutning (Faktiske)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Skøn)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Skøn)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- Scoli-Risk-1
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