Risk Factors for Neurological Complications in Severe Spinal Deformity Surgery

Abstract

Objective: Severe spinal deformities, including scoliosis and kyphosis, present significant challenges in corrective surgery due to the elevated risk of neurological complications. The identification of preoperative risk factors is of paramount importance for the optimization of outcomes and the prevention of complications.

Methods: This retrospective cohort study analyzed 130 patients with severe spinal deformities who underwent surgical treatments from January 2002 to May 2022. A comprehensive collection and analysis of preoperative clinical, imaging, and surgical data were conducted with the objective of identifying risk factors for neurological complications. Univariate and multivariate logistic regression analyses were conducted to ascertain the independent predictors.

Results: A total of 130 patients were included in the study, with a female ratio of 50% and a mean age of 21.4 ± 15.3 years, and 18 (13.8%) of them experienced postoperative neurological complications. Significant factors included preoperative spinal cord anomalies (38.9% in the complication group vs. 8.9% in the non-complication group, p = 0.001) and a higher kyphosis angle (112.4° in the complication group vs. 98.2° in the non-complication group, p = 0.018). The incidence of intraoperative neuromonitoring alarms was significantly higher in the complication group (38.9% vs. 15.9%, p = 0.022). No significant differences were observed in operative time (p = 0.095) or blood loss (p = 0.179). A higher angle of kyphosis (OR = 1.027, 95% CI: 1.001–1.055, p = 0.045) and the occurrence of spinal cord anomalies (OR = 6.715, 95% CI: 1.694–26.615, p = 0.007) were independent predictors of surgical neurological complications.

Conclusions: Preoperative spinal cord anomalies and a higher kyphosis angle are independent risk factors for postoperative neurological complications. A comprehensive preoperative evaluation is essential for optimizing surgical strategies in these high-risk patients.

Keywords

kyphosis / neurological complications / risk factor / scoliosis / spinal deformity

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2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.