Evidence map›Paper›PMID 40632294›Full record

ArticleGlobal spine journal2025

Identification and Management of Neurologic Complications in Patients Undergoing Adult Spinal Deformity Surgery.

Christopher J Nielsen, Justin S Smith, Allan R Martin, Brett Rocos, Thorsten Jentzsch, Robert A Ravinsky, Colby Oitment, Markian Pahuta, So Kato, Stephen J Lewis and 1 more

Abstract read
In one paragraph

Article in Global spine journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Christopher J NielsenSchroeder Arthritis Institute, Department of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada.ORCID 0000-0002-8640-7076
Justin S SmithDepartment of Neurosurgery Surgery, University of Virginia, Charlottesville, VA, USA.ORCID 0000-0003-0467-5534
Allan R MartinAO Knowledge Forum Deformity, Associate Member, Davos, Switzerland.
Brett RocosAO Knowledge Forum Deformity, Associate Member, Davos, Switzerland.ORCID 0000-0002-0808-5585
Thorsten JentzschAO Knowledge Forum Deformity, Associate Member, Davos, Switzerland.ORCID 0000-0002-6133-3314
Robert A RavinskyDepartment of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA.ORCID 0000-0001-7364-143X
Colby OitmentAO Knowledge Forum Deformity, Associate Member, Davos, Switzerland.ORCID 0000-0003-1351-9410
Markian PahutaDivision of Orthopaedic Surgery and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.ORCID 0000-0002-4808-5459
So KatoAO Knowledge Forum Deformity, Associate Member, Davos, Switzerland.
Stephen J LewisSchroeder Arthritis Institute, Department of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada.ORCID 0000-0002-9173-8443
AO Spine Knowledge Forum Deformity

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Study DesignNarrative Literature Review.ObjectiveTo provide a comprehensive literature review of neurologic complications in Adult Spinal Deformity (ASD) surgery in the pre-operative, peri-operative and post-operative periods.MethodsA broad review of the literature was conducted using the multiple databases including Pubmed, Embase, Scopus and the Cochrane library. Individual studies of relevance were appraised and included at the discretion of the authors on the basis of pertinence, impact on practice and scientific merit.ResultsThe evidence regarding epidemiology, classification of complications, pre-operative evaluation of patients, peri-operative strategies to mitigate risk, intra-operative management of neuromonitoring changes and post-operative management of neurologic injury was critically appraised. Patients with the highest risk of neurologic complication include those with pre-surgery neuroaxis abnormality, high Deformity Angular Ratio, 3 column osteotomies and increased blood loss. Accurate and timely identification of intraoperative neuromonitoring changes is critical to ensuring appropriate response depending on whether changes are perfusion based (maintain adequate MAP and Hb, reverse corrective maneuvers) or traumatic (decompression of neural elements, assessment of instrumentation, reversal of corrective maneuvers, steroids). Surgical checklists can help surgeons navigate these stressful events to ensure appropriate steps and interventions are taken.ConclusionNeurological injuries occurring during the course of ASD surgery are potentially devastating complication, with regards to both patient morbidity and economic impact. Pre-operative identification of high risk patients, perioperative strategies to improve safety, timely recognition and management of intra-operative neuromonitoring changes and post-operative supportive measures can potentially reduce the incidence and significance of neurological injuries.

Indexed as

adult spinal deformitydeformity correctionintra-operative neuromonitoringintroaoperative neuromonitoringmotor evoked potentialsnerve root injuryneurologic complicationsneurologic injuryosteotomyspinal cord injury

Identifiers

PMID40632294
PMCPMC12254560

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.