Prevalence and Risk Factors for Postoperative Neurological Complications in Spinal Deformity Surgery: A Systematic Review and Proportional Meta-Analysis

Abstract

Objective: To investigate the incidence of postoperative neurological complications among patients who underwent spinal deformity surgery and to determine the significant risk factors for postoperative neurological complications.

Methods: Six databases PubMed, Web of Science, Scopus, MEDLINE, Embase, and Cochrane Library have been searched to identify observational studies from inception until January 2025. Inclusion criteria were patients aged ≥10 years with postoperative neurological complications after spinal deformity surgery. Stata/MP18.0 was used to conduct the meta-analysis in this review. The summary incidence estimates, proportion with 95% confidence intervals (CIs) and weights were pooled by the random-effects restricted maximum likelihood model.

Results: The search strategy identified 53 articles with 40,958 patients for final review. Overall incidence of postoperative neurological complications was 7% (95% CI, 5.0%-9.0%; p < 0.001; I2 = 98.34%) in which incidence estimates for patients with adult spinal deformity and underwent 3-column spinal osteotomies were 12% (95% CI, 9%-16%; p < 0.001; I2 = 93.17%) and 18% (95% CI, 8%-31%; p < 0.001; I2 = 94.68%) respectively. Preoperative neurological deficit was the risk factor with highest overall odds ratio (OR, 2.86; 95% CI, 1.85-4.41; p = 0.01; I2 = 76.20%), followed by the presence of kyphosis (OR, 1.13; 95% CI, 0.75-1.70; p = 0.02; I2 = 81.80%) and age at surgery (OR, 1.04; 95% CI, 1.01-1.08; p = 0.04; I2 = 68.80%).

Conclusion: Preoperative neurological deficit, the presence of kyphosis and age at surgery were significant risk factors for postoperative neurological complications. Therefore, comprehensive preoperative assessment and surgical planning are crucial to minimize the risk of developing postoperative neurological complications or the deterioration of pre-existing neurologic deficits.

Keywords: Neurological complications; Postoperative complications; Spinal deformity; Spinal deformity surgery.

Fig. 1.

Flow diagram detailing study selection process. Adapted from Page MJ, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71.

Fig. 2.

Forest plot of pooled incidence estimates of postoperative neurologic complications in spinal deformity surgery by type of spinal deformity subgroup. CI, confidence interval; REML, restricted maximum likelihood.

Fig. 3.

Forest plot of pooled incidence estimates of postoperative neurologic complications in spinal deformity surgery by surgical procedure subgroup. CI, confidence interval; 3-CO, 3-column osteotomy; PCO, posterior column osteotomy; PVCR, posterior vertebral column resection; VCR, vertebral column resection; REML, restricted maximum likelihood.