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Neurologic Complications in Spinal Deformity Surgery - Extension

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ClinicalTrials.gov Identifier: NCT02949245
Recruitment Status : Completed
First Posted : October 31, 2016
Last Update Posted : May 19, 2020
Sponsor:
Collaborator:
Scoliosis Research Society
Information provided by (Responsible Party):
AO Foundation, AO Spine

Brief Summary:

272 subjects with "high risk" adult spinal deformity requiring surgical correction were enrolled in the previous prospective multi-center international Scoli-RISK-1 study. "High risk" patients were defined by either their diagnoses and/or the type of surgical intervention as listed in the inclusion criteria. Neurological complications in the form of new motor and sensory deficits were monitored prospectively in all patients at hospital discharge, at 6 weeks (± 2 weeks), 6 months (± 2 months) and 24 months (± 2 months) after the surgery. The relationship to the surgical intervention was assessed in all new deficits.

Regression analyses were used to evaluate the association between patient demographics, co-morbidities, treatment history, spinal deformity characteristics, surgical characteristics, non-neurologic complications and pre-surgical status to occurrence of a neurologic deficit after surgery.

All enrolled Scoli-RISK-1 participants will be re-consented and asked to return for a 5 year FU visit.


Condition or disease Intervention/treatment
Adult Spinal Deformity Procedure: Interventions

Detailed Description:

Although the incidence of complications in patients undergoing correction of their spinal deformity has been reported extensively, the majority of these studies were retrospective. There were only five studies, three from a single institution, with prospectively collected data that specifically identified complications. The largest series was from Buchowski et al who reported on 108 patients with fixed sagittal deformity undergoing Pedicle Subtraction Osteotomy (PSO) with a 14% over-all complication rate with motor weakness in 11 patients and neurogenic bladder in one patient, of which 3 were permanent. Yang reported on 35 patients undergoing PSOs with a 46% over-all complication rate and one transient nerve root motor deficit. As in 2002 reported on 83 patients undergoing various osteotomies for sagittal imbalance and reported a 34% over-all complication rate with 3 permanent and 3 transient nerve root deficits.

Given this lack of information, there is a need to determine the true incidence of complications using a prospective multi-center design. There is a need to identify neurologic deficits in a more systematic fashion to include spinal cord, cauda equina and nerve root deficits as well as radiculopathies. The risk factors associated with the occurrence of a complication, especially a neurologic complication, also needs to be more fully elucidated. This is increasingly relevant, as newer surgical techniques allow for more aggressive correction of the spinal deformity that may put the spinal cord and nerve roots at increased risk. Valid data on the incidence and types of neurologic deficits is also needed in order to study newer drugs that are available that may mitigate this risk.

The primary objectives of this study are: (i) to establish the incidence of neurologic deficit in "high risk" adult patients undergoing correction of their spinal deformity of adult spinal deformity and (ii) to identify characteristics associated with increased risk of neurologic complications. Secondary objectives include (i) to determine the incidence of all complications related to surgical correction of "high risk" adult spinal deformity; (ii) to determine the short-term clinical outcomes in patients undergoing correction of their spinal deformity and (iii).to determine amount of radiographic and clinical correction of deformity

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Study Type : Observational
Actual Enrollment : 77 participants
Observational Model: Case-Only
Time Perspective: Prospective
Official Title: Evaluation of Neurologic Complications Associated With Surgical Correction of Adult Spinal Deformity (Scoli-RISK-1): A Prospective, Observational, Multi-center Study 5 Year Follow-up Extension
Actual Study Start Date : August 17, 2017
Actual Primary Completion Date : December 28, 2019
Actual Study Completion Date : December 28, 2019

Group/Cohort Intervention/treatment
Groups/Cohorts

Surgical treatment

This observational study is examining the outcomes of standard surgical treatments for adult spinal deformity.

Procedure: Interventions

Procedure/Surgery: Routinely performed surgical correction of spinal deformity

Routinely performed surgical correction of spinal deformity





Primary Outcome Measures :
  1. Rate of neurologic complication [ Time Frame: 5 years postoperative ]
    Rate of treatment-related neurological complications determined by the Clinical Endpoint Committee (CEC) whether complications are of neurological nature or not.

  2. Absolute change in motor status as measured by the ASIA LEMS [ Time Frame: between baseline and 5 years postoperative ]

Secondary Outcome Measures :
  1. ASIA Sensory Score [ Time Frame: Change between baseline and 5 years postoperative ]
    Sensory status as measured by the ASIA Sensory Score

  2. ASIA Impairment Scale [ Time Frame: Change between baseline and 5 years postoperative ]
    Neurological status as measured by the ASIA Impairment Scale

  3. SRS-22R [ Time Frame: Change between baseline and 5 years postoperative ]
    Function, pain and self-image as measured by the SRS-22R

  4. ODI v2.1a [ Time Frame: Change between baseline and 5 years postoperative ]
    Functional impairment as measured by the ODI v2.1a score

  5. SF-36 v2.0 [ Time Frame: Change between baseline and 5 years postoperative ]
    Quality of life as measured by the SF-36 v2.0

  6. Radiographic measures [ Time Frame: Change between baseline and 5 years postoperative ]
    major coronal curve, coronal balance, sagital alignment, T2-T12 sagital cobb, T12-S1 sagital cobb, major sagital curve



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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Participant completed Scoli-RISK-1 study are potential subjects for this observational study.
Criteria

Inclusion Criteria:

  • Participant completed Scoli-RISK-1 study (no withdraws or drop-outs)
  • Signed informed consent for extended study

Exclusion Criteria:

  • Subjects enrolled in Scoli-RISK-1 which are unlikely to comply with the FU
  • Subjects which by law are not eligible to participate any longer in clinical trials

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02949245


Locations
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United States, California
University of California
San Francisco, California, United States, 94118
United States, Maryland
Johns Hopkins University
Baltimore, Maryland, United States, 21205
United States, Missouri
Department of Orthopaedic Surgery, Washington University School of Medicine
Saint Louis, Missouri, United States, 63110
United States, New York
NYU School of Medicine
New York, New York, United States, 10023
United States, Virginia
University of Virginia
Charlottesville, Virginia, United States, 22903
Canada, Ontario
University of Toronto Hospital
Toronto, Ontario, Canada, M5T 2S8
China
University of Hong Kong
Hong Kong, China, 102
Nanjing Drum Tower Hospital
NanJing, China, 210008
Japan
Hamamatsu University School of Medicine
Hamamatsu, Japan, 3192
Spain
Hospital Universitari Vall D'Hebron
Barcelona, Spain, 08035
United Kingdom
University Hospital Nottingham, NHS Trust
Nottingham, United Kingdom, NG7 2UH
Sponsors and Collaborators
AO Foundation, AO Spine
Scoliosis Research Society
Investigators
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Principal Investigator: Lawrence Lenke, MD Scoliosis Research Society
Additional Information:
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Responsible Party: AO Foundation, AO Spine
ClinicalTrials.gov Identifier: NCT02949245    
Other Study ID Numbers: Scoli-RISK-1 extension
First Posted: October 31, 2016    Key Record Dates
Last Update Posted: May 19, 2020
Last Verified: May 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by AO Foundation, AO Spine:
Spine
Surgery
Prospective Studies
Deformity
Neurologic deficit
Additional relevant MeSH terms:
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Congenital Abnormalities