Prognostic Factors of Neurological Complications in Spinal Surgeries
10.31616/asj.2018.12.4.734
- Author:
Won Shik SHIN
1
;
Dong Ki AHN
;
Jung Soo LEE
;
Ki Hyuk KOO
;
In Seon YOO
Author Information
1. Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea. adk0208@hanmail.net
- Publication Type:Original Article
- Keywords:
Spinal surgery;
Neurological complication;
Treatment;
Prognosis
- MeSH:
Decompression;
Diskectomy;
Heart;
Hematoma;
Hospitals, General;
Humans;
Hypesthesia;
Leg;
Paraparesis;
Paraplegia;
Paresis;
Prognosis;
Retrospective Studies;
Seoul;
Weights and Measures
- From:Asian Spine Journal
2018;12(4):734-742
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
