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Neurologic Complications in Spinal Deformity Surgery

23 december 2015 bijgewerkt door: AO Foundation, AO Spine

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.

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

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

Studietype

Observationeel

Inschrijving (Werkelijk)

273

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Canada
      • Toronto, Canada, M5T 2S8
        • University of Toronto
  • China
      • Hong Kong, China, 102
        • University of Hong Kong
      • NanJing, China, 210008
        • Nanjing Drum Tower Hospital
  • Denemarken
      • Copenhagen, Denemarken, 2100
        • Rigshospitalet
  • Japan
      • Hamamatsu, Japan, 3192
        • University School of Medicine
  • Spanje
      • Barcelona, Spanje, 08035
        • Hospital Universitari Vall d'Hebron
  • Verenigd Koninkrijk
      • Nottingham, Verenigd Koninkrijk, NG7 2UH
        • University Hospital Nottingham, NHS Trust
  • Verenigde Staten
    • California
      • San Francisco, California, Verenigde Staten, 94118
        • University of California
    • Kentucky
      • Louisville, Kentucky, Verenigde Staten, 40202
        • Norton Leatherman Spine Center
    • Maryland
      • Baltimore, Maryland, Verenigde Staten, 21205
        • Johns Hopkins University
    • Minnesota
      • Rochester, Minnesota, Verenigde Staten, 55905
        • Mayo Clinic
    • Missouri
      • Saint Louis, Missouri, Verenigde Staten, 63110
        • Department of Orthopaedic Surgery, Washington University School of Medicine
    • New York
      • New York, New York, Verenigde Staten, 10021
        • Hospital for Special Surgery
      • Yew York, New York, Verenigde Staten, 10023
        • NYU School of Medicine
    • Virginia
      • Charlottesville, Virginia, Verenigde Staten, 22903
        • University of Virginia

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar tot 80 jaar (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Bemonsteringsmethode

Niet-waarschijnlijkheidssteekproef

Studie Bevolking

Patients receiving care at the investigative sites will be pre-screened as potential subjects for this observational study study.

Beschrijving

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

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

Cohorten en interventies

Groep / Cohort
Interventie / Behandeling
Surgical treatment
This observational study is examining the outcomes of standard surgical treatments for adult spinal deformity.
Procedure: Routinely performed surgical correction of spinal deformity
Routinely performed surgical correction of spinal deformity

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Rate of treatment-related neurologic complication
Tijdsspanne: 6 months
  • Spinal Cord Deficit
  • Cauda Equina Deficit

  • Nerve Root Deficit

    • Motor Deficit
    • Sensory Deficit
    • Radiculopathy
6 months

Secundaire uitkomstmaten

Uitkomstmaat
Tijdsspanne
• Sensory status as measured by the ASIA Sensory Score
Tijdsspanne: 6 months
6 months

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

AO Foundation, AO Spine

Medewerkers

Scoliosis Research Society

Onderzoekers

  • Hoofdonderzoeker: Lawrence Lenke, MD, Scoliosis Research Society

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Algemene publicaties

Nuttige links

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 augustus 2011

Primaire voltooiing (Werkelijk)

1 november 2014

Studie voltooiing (Werkelijk)

1 maart 2015

Studieregistratiedata

Eerst ingediend

25 februari 2011

Eerst ingediend dat voldeed aan de QC-criteria

25 februari 2011

Eerst geplaatst (Schatting)

28 februari 2011

Updates van studierecords

Laatste update geplaatst (Schatting)

24 december 2015

Laatste update ingediend die voldeed aan QC-criteria

23 december 2015

Laatst geverifieerd

1 december 2015

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • Scoli-Risk-1

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