Risk factors and clinical impact of perioperative neurological deficits following thoracolumbar arthrodesis

Abstract

Objectives: The rates of arthrodesis performed in the United States and globally have increased tremendously in the last 10–15 years. Amongst the most devastating complications are neurological deficits including spinal cord injury, nerve root irritation, and cauda equine syndrome. The primary purpose of this study is to understand the risk factors for perioperative neurological deficits in patients undergoing thoracolumbar fusion. Patients and methods: Data from the Nationwide Inpatient Sample between the years of 1999–2011 was analyzed. Patients were between the ages of 18 and 80 who had thoracolumbar fusion. Excluded were patients who underwent the procedure as a result of trauma or a malignancy. A list of covariates, including demographic variables, preoperative and postoperative variables that are known to increase the risk of perioperative neurological deficits were compiled. Statistical analysis utilized univariate and multivariate logistic regression for comparisons between these covariates and the proposed outcomes. Results: The analysis of 37,899 patients yielded an overall rate of perioperative neurological deficits and mortality of 1.20% and 0.27%, respectively. Risk factors for perioperative neurological deficits included increasing age (OR 1.023 95% CI 1.018–1.029), Van Walraven 5–14 (OR 1.535 95% CI 1.054–2.235), and preoperative paralysis (OR 2.551 95% CI 1.674–3.886). Furthermore, the data showed that being 65 years old or older doubled the risk for perioperative deficit (OR 1.655, CI 1.248–2.194, p < 0.001). Conclusions: This population based study found that increasing age, higher comorbid burden, and preoperative paralysis increased the risk of perioperative neurological deficits while female gender and hypertension were found to be protective. Keywords: Thoracolumbar fusion, Arthrodesis, Spine, Neurological deficits, Mortality, National Inpatient Sample, Outcomes, Complications