Skip to main content
SpringerLink
Log in

The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Introduction

Neurologic complications after complex adult spinal deformity (ASD) surgery are important, yet outcomes are heterogeneously reported, and long-term follow-up of actual lower extremity motor function is unknown.

Objective

To prospectively evaluate lower extremity motor function scores (LEMS) before and at 5 years after surgical correction of complex ASD.

Design

Retrospective analysis of a prospective, multicenter, international observational study.

Methods

The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers around the world. Inclusion criteria were Cobb angle of > 80°, corrective osteotomy for congenital or revision deformity and/or 3-column osteotomy. Among patients with 5-year follow-up, comparisons of LEMS to baseline and within each follow-up period were made via documented neurologic exams on each patient.

Results

Seventy-seven (28.3%) patients had 5-year follow-up. Among these 77 patients with 5-year follow-up, rates of postoperative LEMS deterioration were: 14.3% hospital discharge, 10.7% at 6 weeks, 6.5% at 6 months, 9.5% at 2 years and 9.3% at 5 years postoperative. During the 2–5 year window, while mean LEMS did not change significantly (−0.5, p = 0.442), eight (11.1%) patients deteriorated (of which 3 were ≥ 4 motor points), and six (8.3%) patients improved (of which 2 were ≥ 4 points). Of the 14 neurologic complications, four (28.6%) were surgery-related, three of which required reoperation. While mean LEMS were not impacted in patients with a major surgery-related complication, mean LEMS were significantly lower in patients with neurologic surgery-related complications at discharge (p = 0.041) and 6 months (p = 0.008) between the two groups as well as the change from baseline to 5 years (p = 0.041).

Conclusions

In 77 patients undergoing complex ASD surgery with 5-year follow-up, while mean LEMS did not change from 2 to 5 years, subtle neurologic changes occurred in approximately 1 in 5 patients (11.1% deteriorated; 8.3% improved). Major surgery-related complication did not result in decreased LEMS; however, those with neurologic surgery-related complications continued to have decreased lower extremity motor function at 5 years postoperative. These results underscore the importance of long-term follow-up to 5 years, using individual motor scores rather than group averages, and comparing outcomes to both baseline and last follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Diebo BG, Shah NV, Boachie-Adjei O, Zhu F, Rothenfluh DA, Paulino CB et al (2019) Adult spinal deformity. Lancet 394(10193):160–172. https://doi.org/10.1016/S0140-6736(19)31125-0

    Article  PubMed  Google Scholar 

  2. Bess S, Line B, Fu KM, McCarthy I, Lafage V, Schwab F, et al. (2016) The Health Impact of Symptomatic Adult Spinal Deformity Comparison of Deformity Types to United States Population Norms and Chronic Diseases. Spine. 41(3): 224–33. doi: https://doi.org/10.1097/BRS.0000000000001202.

  3. Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, et al. (2009) Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976). 34(20):2171–8. doi: https://doi.org/10.1097/BRS.0b013e3181a8fdc8.

  4. Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton W, et al. (2009) Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976). 34(16):1693–8. doi: https://doi.org/10.1097/BRS.0b013e3181ac5fcd.

  5. Smith JS, Shaffrey E, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ et al (2014) Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine 21(6):994–1003. https://doi.org/10.3171/2014.9.SPINE131176

    Article  PubMed  Google Scholar 

  6. Yadla S, Maltenfort MG, Ratliff JK, Harrop JS (2010) Adult scoliosis surgery outcomes: a systematic review. Neurosurg Focus 28(3):E3. https://doi.org/10.3171/2009.12.FOCUS09254

    Article  PubMed  Google Scholar 

  7. Passias PG, Soroceanu A, Yang S, Schwab F, Ames C, Boniello A et al (2016) Predictors of revision surgical procedure excluding wound complications in adult spinal deformity and impact on patient-reported outcomes and satisfaction: a two-year follow-up. J Bone Joint Surg Am 98(7):536–543. https://doi.org/10.2106/JBJS.14.01126

    Article  PubMed  Google Scholar 

  8. Scheer JK, Tang JA, Smith JS, Klineberg E, Hart RA, Mundis GM Jr et al (2013) Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database: clinical article. J Neurosurg Spine 19(4):464–470. https://doi.org/10.3171/2013.7.SPINE12901

    Article  PubMed  Google Scholar 

  9. Cerpa M, Lenke LG, Fehlings MG, Shaffrey CI, Cheung KMC, Carreon LY (2019) Evolution and advancement of adult spinal deformity research and clinical care: an overview of the scoli-risk-1 study. Global Spine J 9(1 Suppl):8S-14S. https://doi.org/10.1177/2192568219828729

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A et al (2011) International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med 34(6):535–546. https://doi.org/10.1179/204577211X13207446293695

    Article  PubMed  PubMed Central  Google Scholar 

  11. Graves DE, Frankiewicz RG, Donovan WH (2006) Construct validity and dimensional structure of the ASIA motor scale. J Spinal Cord Med 29(1):39–45. https://doi.org/10.1080/10790268.2006.11753855

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lenke LG, Shaffrey CI, Carreon LY, Cheung KMC, Dahl BT, Fehlings MG et al (2018) Lower extremity motor function following complex adult spinal deformity surgery: two-year follow-up in the scoli-risk-1 prospective, multicenter, international study. J Bone Joint Surg Am 100(8):656–665. https://doi.org/10.2106/JBJS.17.00575

    Article  PubMed  Google Scholar 

  13. Carreon LY, Glassman SD, Shaffrey CI, Fehlings MG, Dahl B, Ames CP et al (2017) Predictors of health-related quality-of-life after complex adult spinal deformity surgery: a scoli-risk-1 secondary analysis. Spine Deform 5(2):139–144. https://doi.org/10.1016/j.jspd.2016.11.001

    Article  PubMed  Google Scholar 

  14. Asher MA, Lai SM, Glattes RC, Burton DC, Alanay A, Bago J. (2006) Refinement of the SRS-22 Health-Related Quality of Life questionnaire Function domain. Spine (Phila Pa 1976). 31(5):593–7. doi: https://doi.org/10.1097/01.brs.0000201331.50597.ea.

  15. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66(8):271–273

    CAS  PubMed  Google Scholar 

  16. Fairbank JC, Pynsent PB. (2000) The Oswestry Disability Index. Spine (Phila Pa 1976). 25(22):2940–52; discussion 52. doi: https://doi.org/10.1097/00007632-200011150-00017.

  17. Ware JE, Jr. (2000) SF-36 health survey update. Spine (Phila Pa 1976). 25(24):3130–9. doi: https://doi.org/10.1097/00007632-200012150-00008.

  18. Ware JE, Jr., Sherbourne CD. (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 30(6):473–83.

  19. Kelly MP, Lenke LG, Shaffrey CI, Ames CP, Carreon LY, Lafage V et al (2014) Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study. Neurosurg Focus 36(5):E17. https://doi.org/10.3171/2014.2.FOCUS1419

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fehlings MG, Kato S, Lenke LG, Nakashima H, Nagoshi N, Shaffrey CI et al (2018) Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study. Spine J 18(10):1733–1740. https://doi.org/10.1016/j.spinee.2018.02.001

    Article  PubMed  Google Scholar 

  21. Khashan M, Raad M, El Dafrawy MH, Puvanesarajah V, Kebaish KM (2019) Postoperative changes in neurological function after 3-column osteotomy: risk factor analysis of 199 patients. J Neurosurg Spine. https://doi.org/10.3171/2018.11.SPINE18698

    Article  PubMed  Google Scholar 

  22. Tuchman A, Lenke LG, Cerpa M, Fehlings MG, Lewis SJ, Shaffrey CI et al (2019) 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? Spine J 19(3):395–402. https://doi.org/10.1016/j.spinee.2018.08.003

    Article  PubMed  Google Scholar 

  23. Kato S, Fehlings MG, Lewis SJ, Lenke LG, Shaffrey CI, Cheung KMC, et al. (2018) An Analysis of the Incidence and Outcomes of Major Versus Minor Neurological Decline After Complex Adult Spinal Deformity Surgery: A Subanalysis of Scoli-RISK-1 Study. Spine (Phila Pa 1976). 43(13):905–12. doi: https://doi.org/10.1097/BRS.0000000000002486.

  24. Anand N, Baron EM, Khandehroo B, Kahwaty S. (2013) Long-term 2- to 5-year clinical and functional outcomes of minimally invasive surgery for adult scoliosis. Spine (Phila Pa 1976). 38(18):1566–75. doi: https://doi.org/10.1097/BRS.0b013e31829cb67a.

  25. Bridwell KH, Baldus C, Berven S, Edwards C, 2nd, Glassman S, Hamill C, et al. (2010) Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three- to five-years follow-up. Spine (Phila Pa 1976). 35(20):1849–54. doi: https://doi.org/10.1097/BRS.0b013e3181efa06a.

  26. Adogwa O, Karikari IO, Elsamadicy AA, Sergesketter AR, Galan D, Bridwell KH (2018) Correlation of 2-year SRS-22r and ODI patient-reported outcomes with 5-year patient-reported outcomes after complex spinal fusion: a 5-year single-institution study of 118 patients. J Neurosurg Spine 29(4):422–428. https://doi.org/10.3171/2018.2.SPINE171142

    Article  PubMed  Google Scholar 

  27. Kyrola K, Kautiainen H, Pekkanen L, Makela P, Kiviranta I, Hakkinen A (2019) Long-term clinical and radiographic outcomes and patient satisfaction after adult spinal deformity correction. Scand J Surg 108(4):343–351. https://doi.org/10.1177/1457496918812201

    Article  CAS  PubMed  Google Scholar 

  28. Ploumis A, Simpson AK, Cha TD, Herzog JP, Wood KB (2015) Coronal spinal balance in adult spine deformity patients with long spinal fusions: a minimum 2- to 5-year follow-up study. J Spinal Disord Tech 28(9):341–347. https://doi.org/10.1097/BSD.0b013e3182aab2ff

    Article  PubMed  Google Scholar 

  29. Raman T, Miller E, Martin CT, Kebaish KM (2017) The effect of prophylactic vertebroplasty on the incidence of proximal junctional kyphosis and proximal junctional failure following posterior spinal fusion in adult spinal deformity: a 5-year follow-up study. Spine J 17(10):1489–1498. https://doi.org/10.1016/j.spinee.2017.05.017

    Article  PubMed  Google Scholar 

  30. Yoshida G, Hasegawa T, Yamato Y, Kobayashi S, Shin O, Banno T et al (2019) Minimum clinically important differences in oswestry disability index domains and their impact on adult spinal deformity surgery. Asian Spine J 13(1):35–44. https://doi.org/10.31616/asj.2018.0077

    Article  PubMed  Google Scholar 

  31. McCarthy I, O’Brien M, Ames C, Robinson C, Errico T, Polly DW Jr et al (2014) Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery. Neurosurg Focus 36(5):E3. https://doi.org/10.3171/2014.3.FOCUS1415

    Article  PubMed  Google Scholar 

  32. Kim YJ, Bridwell KH, Lenke LG, Glattes CR, Rhim S, Cheh G. (2008) Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up. Spine (Phila Pa 1976). 33(20):2179–84. doi: https://doi.org/10.1097/BRS.0b013e31817c0428.

  33. Kim YB, Lenke LG, Kim YJ, Kim YW, Blanke K, Stobbs G, et al. (2009) The morbidity of an anterior thoracolumbar approach: adult spinal deformity patients with greater than five-year follow-up. Spine (Phila Pa 1976). 34(8):822–6. doi: https://doi.org/10.1097/BRS.0b013e31818e3157.

  34. Hasegawa T, Ushirozako H, Yamato Y, Togawa D, Yoshida G, Kobayashi S et al (2020) Impact of adult spinal deformity corrective surgery in patients with the symptoms of gastroesophageal reflux disease: a 5-year follow-up report. Eur Spine J 29(4):860–869. https://doi.org/10.1007/s00586-020-06300-2

    Article  PubMed  Google Scholar 

  35. Taneichi H, Inami S, Moridaira H, Takeuchi D, Sorimachi T, Ueda H et al (2020) Can we stop the long fusion at L5 for selected adult spinal deformity patients with less severe disability and less complex deformity? Clin Neurol Neurosurg 194:105917. https://doi.org/10.1016/j.clineuro.2020.105917

    Article  PubMed  Google Scholar 

  36. Glassman SD, Hamill CL, Bridwell KH, Schwab FJ, Dimar JR, Lowe TG. (2007) The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine (Phila Pa 1976). 32(24):2764–70. doi: https://doi.org/10.1097/BRS.0b013e31815a7644.

  37. Riley MS, Bridwell KH, Lenke LG, Dalton J, Kelly MP (2018) Health-related quality of life outcomes in complex adult spinal deformity surgery. J Neurosurg Spine 28(2):194–200. https://doi.org/10.3171/2017.6.SPINE17357

    Article  PubMed  Google Scholar 

  38. Faloon MJ, Essig D, Cho W, Sokunbi G, Ross T, Cunningham ME et al (2015) Unplanned reoperations affect long-term outcomes in adult spinal deformity patients undergoing long fusions to the sacrum. Spine Deform 3(4):367–371. https://doi.org/10.1016/j.jspd.2015.02.005

    Article  PubMed  Google Scholar 

Download references

Funding

This study was funded by AO Spine through the AO Spine Knowledge Forum Deformity, the Scoliosis Research Society (SRS), and Norton Healthcare. AO Spine Knowledge Forum Deformity is a focused group of international deformity experts. AO Spine is a clinical division of the AO Foundation, which is an independent medically guided not-for-profit organization. Study support was provided directly through the AO Spine Research Department and the AO Innovation Translation Center, Clinical Evidence.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, 10032, USA

    Lawrence G. Lenke, Scott L. Zuckerman & Meghan Cerpa

  2. Duke University Medical Center, Durham, NC, USA

    Christopher I. Shaffrey

  3. Norton Leatherman Spine Center, Louisville, KY, USA

    Leah Y. Carreon

  4. Li Ka Shing, Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong

    Kenneth M. C. Cheung

  5. Washington University in St. Louis, St. Louis MO, USA

    Michael P. Kelly

  6. University of Toronto and Toronto Western Hospital, Toronto, ON, Canada

    Michael G. Fehlings & Stephen J. Lewis

  7. University of California San Francisco, San Francisco, CA, USA

    Christopher P. Ames

  8. The FOCOS Hospital, Pantang West, Republic of Ghana

    Oheneba Boachie-Adjei

  9. Marshfield Clinic Eau Claire Center, Eau Claire, WI, USA

    Mark B. Dekutoski

  10. Johns Hopkins University, Baltimore, MD, USA

    Khaled M. Kebaish

  11. Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Yukihiro Matsuyama

  12. Hospital Universitari Vall D’Hebron, Barcelona, Spain

    Ferran Pellisé

  13. Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

    Yong Qiu

  14. Hospital for Special Surgery, New York, NY, USA

    Frank J. Schwab

  15. University of Virginia, Charlottesville, VA, USA

    Justin S. Smith

Authors
  1. Lawrence G. Lenke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Scott L. Zuckerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meghan Cerpa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher I. Shaffrey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leah Y. Carreon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenneth M. C. Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael P. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael G. Fehlings
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christopher P. Ames
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Oheneba Boachie-Adjei
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mark B. Dekutoski
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Khaled M. Kebaish
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Stephen J. Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yukihiro Matsuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Ferran Pellisé
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Yong Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Frank J. Schwab
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Justin S. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

AO Spine Knowledge Forum Deformity and SRS Scoli-RISK-1 Study Group

Corresponding author

Correspondence to Lawrence G. Lenke.

Ethics declarations

Conflicts of interest

The authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Columbia University Medical Center (#AAAR2375).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

*This work has been accepted for an oral presentation at the 2020 virtual SRS conference.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 27 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lenke, L.G., Zuckerman, S.L., Cerpa, M. et al. The Scoli-RISK 1 results of lower extremity motor function 5 years after complex adult spinal deformity surgery. Eur Spine J 30, 3243–3254 (2021). https://doi.org/10.1007/s00586-021-06969-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-021-06969-z

Keywords

Search

Navigation