European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026
Postoperative neurological deficits following thoracic decompression surgery: incidence, trajectory, and resolution.
СтатьяНазвание и аннотация: Перевод в очереди
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Ghenbot Sennay, Patel Hershil, Patel Sapan, Suresh Rohan I, Chiu Anthony K, Sahai Amil, Prakash Hans, Honig Evan, Curto Ryan, Zareef Usman, Shear Brian, Amin Idris, Padovano Alexander, Bivona Louis J, Cavanaugh Daniel L, Koh Eugene Y, Ludwig Steven C, Jauregui Julio J
Аннотация
PURPOSE: To characterize neurological outcomes after thoracic decompression and to identify patient- and procedure-level factors associated with persistent postoperative neurological deficits across a multi-etiology cohort, with explicit pathology-stratified analysis.
METHODS: We retrospectively reviewed 255 patients who underwent thoracic decompression from 2016 to 2023 for degenerative disease (n = 102), trauma (n = 53), infection (n = 37), tumor (n = 28), or deformity (n = 35), classified under a mutually exclusive primary-indication scheme. Neurological deficits were assessed pre- and postoperatively using the ASIA Impairment Scale and detailed neurological examinations. Outcomes were stratified by surgical indication to address inherent pathologic heterogeneity. Categorical comparisons used chi-square or Fisher's exact tests; significance threshold p < 0.05 for hypothesis-driven analyses, with p < 0.001 retained for the descriptive comorbidity comparisons in Tables 4, 5 and 6 due to the large number of contrasts.
RESULTS: The cohort comprised 255 patients (mean age 62.6 ± 13.8 years; 51.4% female). New postoperative neurologic deficits occurred in 68 patients (26.7%) and were uniformly distributed across surgical indications (range 20.0-31.4%, p = 0.566), supporting a procedure-level interpretation of the aggregate risk. Recovery prospects, however, differed significantly by indication: persistent deficits at one year occurred in 2 of 25 evaluable degenerative cases (8.0%) versus 7 of 19 non-degenerative cases (36.8%; Fisher's exact p = 0.027). Baseline and postoperative neurologic burden also differed substantially by indication, with trauma patients showing the most severe deficits at both time points (preoperative ASIA A-C 34.0% vs. 4.9% in degenerative, p < 0.001; postoperative motor deficit 54.7% vs. 29.4%, p < 0.001; postoperative bowel/bladder dysfunction 22.6% vs. 8.8%, p = 0.008). Median time to deficit resolution was 23 days (IQR 9-68).
CONCLUSION: New postoperative neurological deficits after thoracic decompression occurred in approximately one in four patients in this pathology-inclusive cohort. Most deficits with adequate follow-up resolved, but persistent deficits occurred in a clinically meaningful subset and could not be fully determined in patients lost to follow-up before one year. Although the incidence of new postoperative deficit was similar across indications, recovery appeared to vary by pathology, with lower persistent-deficit rates among evaluable degenerative cases than non-degenerative cases. These findings are descriptive and hypothesis-generating and should be validated in larger, pathology-specific cohorts with complete longitudinal follow-up.
METHODS: We retrospectively reviewed 255 patients who underwent thoracic decompression from 2016 to 2023 for degenerative disease (n = 102), trauma (n = 53), infection (n = 37), tumor (n = 28), or deformity (n = 35), classified under a mutually exclusive primary-indication scheme. Neurological deficits were assessed pre- and postoperatively using the ASIA Impairment Scale and detailed neurological examinations. Outcomes were stratified by surgical indication to address inherent pathologic heterogeneity. Categorical comparisons used chi-square or Fisher's exact tests; significance threshold p < 0.05 for hypothesis-driven analyses, with p < 0.001 retained for the descriptive comorbidity comparisons in Tables 4, 5 and 6 due to the large number of contrasts.
RESULTS: The cohort comprised 255 patients (mean age 62.6 ± 13.8 years; 51.4% female). New postoperative neurologic deficits occurred in 68 patients (26.7%) and were uniformly distributed across surgical indications (range 20.0-31.4%, p = 0.566), supporting a procedure-level interpretation of the aggregate risk. Recovery prospects, however, differed significantly by indication: persistent deficits at one year occurred in 2 of 25 evaluable degenerative cases (8.0%) versus 7 of 19 non-degenerative cases (36.8%; Fisher's exact p = 0.027). Baseline and postoperative neurologic burden also differed substantially by indication, with trauma patients showing the most severe deficits at both time points (preoperative ASIA A-C 34.0% vs. 4.9% in degenerative, p < 0.001; postoperative motor deficit 54.7% vs. 29.4%, p < 0.001; postoperative bowel/bladder dysfunction 22.6% vs. 8.8%, p = 0.008). Median time to deficit resolution was 23 days (IQR 9-68).
CONCLUSION: New postoperative neurological deficits after thoracic decompression occurred in approximately one in four patients in this pathology-inclusive cohort. Most deficits with adequate follow-up resolved, but persistent deficits occurred in a clinically meaningful subset and could not be fully determined in patients lost to follow-up before one year. Although the incidence of new postoperative deficit was similar across indications, recovery appeared to vary by pathology, with lower persistent-deficit rates among evaluable degenerative cases than non-degenerative cases. These findings are descriptive and hypothesis-generating and should be validated in larger, pathology-specific cohorts with complete longitudinal follow-up.