Delayed Postoperative Neurologic Deficit After Spine Deformity Surgery: Analysis of 5377 Cases at 1 Institution

BACKGROUND: To our knowledge, few studies have focused on delayed postoperative neurologic deficit (DPND) after spine deformity surgery. OBJECTIVES: This study was intended to investigate the incidence, risk factors, treatments, and outcomes of DPND after corrective surgery for spinal deformity in a single spine center. METHODS: The database of a single spine center was queried for dates from 2002 to 2014 to identify all spinal deformity cases. The variables extracted included patient age, diagnosis, procedure, whether neuromonitoring was used and if so which methods were used, whether neuromonitoring abnormalities were detected, whether new neurologic deficits occurred, whether implants were used, and the degree of recovery from new neurologic deficits (none, partial, complete). The patients were classified as pediatric (<21 years old) or adult (>= 21 years old). The rates of DPND were tabulated and stratified on the basis of age, diagnosis, and surgical features. RESULTS: A total of 5377 cases were investigated from 2002 through 2014. Seven cases of DPND were reported (incidence, 0.13%). For adult patients, the overall incidence of DPND was 0.17%, and for pediatric patients, it was 0.10%. The incidence of DPND was 0.35% when osteotomies were performed and 0.05% without osteotomies. After the onset of neurologic deficits, loss of somatosensory evoked potentials occurred in 1 patient, and loss of motor evoked potentials occurred in all 7 patients. Revision surgery was performed for 3 patients. At the last follow-up visit, 1 patient experienced no recovery, 2 partial recovery, and 5 complete recovery. CONCLUSIONS: The incidence of DPND is low. Old age and osteotomies are risk factors for DPND. Most patients with DPND experience varying degrees of recovery.