Predictors of Neurological Motor Decline in Complex Adult Spinal Deformity Surgery: Results of the Prospective, International, Multicenter Scoli-RISK-1 Study
Bibliographic record
Abstract
Introduction Significant variability in neurologic outcomes following surgical correction for ASD has been reported. Risk factors for decline in neurologic motor outcomes are poorly understood. The objective of this prospective, multicenter, international cohort study in 15 sites is to evaluate the incidence and risk factors for postoperative neurological motor decline in patients undergoing surgery for complex adult spinal deformity (ASD). Material and Methods From September 2011 to October 2012, 273 consecutive patients were prospectively enrolled. One patient lacked baseline ASIA lower extremity motor score (LEMS), and one patient did not have follow-up LEMS leaving 271 (99.27%) subjects for analysis. Decline in neurologic motor outcomes was defined as deterioration in any of discharge or 6 weeks American Spinal Injury Association (ASIA) Lower Extremity Motor Scores (LEMS) compared with pre-operative status. To identify risk factors associated with decline in LEMS, two step statistical analysis was performed. First, 128 candidate variables consisting of demographics, comorbidities, treatment history, disease severity, radiologic parameters and surgical details were screened in bi-variate models. Then, 53 variables that had a p-value of 0.2 or less were included in a multivariate logistic stepwise model. Results 70 (25.93%) patients showed decline and 200 (74.07%) had no decline in LEMS. Of those with a decline, nine patients (overall rate of 3.33%) had a severe deterioration of > 10 points on LEMS scale. Key factors associated with postoperative neurological deterioration included older age, non East Asian ethnicity, cardiovascular disease, preoperative motor weakness, kyphosis on T12 – S1, focal severe deformity angle, pedicle subtraction osteotomy, thoracic level fusion and intraoperative motor evoked potential change. Conclusion Although complex ASD surgery can enhance the quality of life of adult patients with severe deformity, a significant portion of patients with ASD experience a postoperative decline in LEMS. The risk factors identified in this study are useful to help clinicians to anticipate and potentially develop strategies to reduce the risk of postoperative neurologic complications.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".