{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T19:59:03Z","timestamp":1772827143228,"version":"3.50.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The aim of this study was to determine if there are any specific procedural, demographic, and\/or radiographic factors that are associated with an improved postoperative lower extremity (LE) motor score (LEMS) among patients with adult spinal deformity (ASD) and abnormal baseline LEMS undergoing surgical correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients with ASD enrolled in an observational prospective study from 2018 to 2023 at 13 spinal deformity centers in North America were queried. Eligible participants met at least one of the following radiographic and\/or procedural inclusion criteria: pelvic incidence minus lumbar lordosis mismatch \u2265 25\u00b0, T1 pelvic angle \u2265 30\u00b0, SVA \u2265 15 cm, thoracic scoliosis \u2265 70\u00b0, thoracolumbar scoliosis \u2265 50\u00b0, global coronal malalignment \u2265 7 cm, underwent 3-column osteotomy (3CO), spinal fusion \u2265 12 levels, and\/or age \u2265 65 years with \u2265 7 levels of instrumentation. Patients with a baseline abnormal LEMS were dichotomized based on whether the LEMS improved or deteriorated from baseline by the 6-week postoperative visit. Patients with a maintained LEMS by 6 weeks compared with baseline were excluded. Patient and operative characteristics were compared through bivariate analyses to assess differences in treatment. A multivariable logistic regression model was built to discern independent factors associated with improved LEMS while controlling for potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 121 patients (77 female, mean age 62.9 years) included in the study, 109 (90.1%) improved and 12 (9.9%) experienced further deterioration from baseline to 6 weeks. Both groups had similar baseline LEMS by laterality and per nerve root. The groups were similar in age, sex, comorbidities, baseline LEMS, BMI, surgical indication, number of instrumented levels, estimated blood loss, operating room time, and hospital length of stay (p &gt; 0.05). No differences in radiographic parameters at baseline and 6 weeks were observed aside from patients whose score had deteriorated experiencing greater change in the L1 pelvic angle (\u2206L1PA) (\u22128.0\u00b0 \u00b1 8.3\u00b0 vs \u22121.6\u00b0 \u00b1 7.6\u00b0, p = 0.0413). Despite having similar frequencies of lumbar decompressions performed across a similar number of levels, patients whose conditions had deteriorated at 6 weeks had fewer lumbar posterior column osteotomies (PCOs) performed (50% vs 82.6%, p = 0.0169). No differences in in the frequency and number of 3COs performed were observed. Patients whose score had deteriorated experienced greater intraoperative neurophysiological monitoring (IONM) changes (41.7% vs 8.3%, p = 0.0050), all of which were motor deficits. Controlling for \u2206L1PA and IONM changes revealed lumbar PCOs to be an independent driver of improved LEMS (OR 4.99 [95% CI 1.05\u201323.70]), with excellent model performance (p = 0.0031, area under the receiver operating characteristic curve of 0.77, Hosmer-Lemeshow goodness-of-fit test p = 0.3017).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Performing lumbar decompressions alone might not be enough to improve LE weakness in patients with ASD and preoperative motor impairment, while the use of PCO was beneficial for improvement. Thus, more aggressive and thorough decompressions afforded by a combined approach of lumbar PCOs and decompression should be considered in this patient population to optimize postoperative motor strength.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.3.spine241469","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:34:48Z","timestamp":1757687688000},"page":"385-395","source":"Crossref","is-referenced-by-count":0,"title":["The role of posterior column osteotomies versus lumbar decompressions in improving lower extremity motor strength in adult spinal deformity patients with preoperative motor impairment"],"prefix":"10.3171","volume":"43","author":[{"given":"Fthimnir M.","family":"Hassan","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence G.","family":"Lenke","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"Lewerenz","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Och Spine Hospital\/Columbia University Irving Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric O.","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Texas Physicians Spine Clinic, Bellaire, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Northwell Health Lenox Hill, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. Kojo","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey L.","family":"Gum","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Northwell Health Lenox Hill, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Mullin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University at Buffalo, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael P.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rady Children\u2019s Hospital, San Diego, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bassel G.","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Orthopedics, Brown University, Providence, Rhode Island;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas J.","family":"Buell","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaled","family":"Kebaish","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins Medical Institute, Baltimore, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Eastlack","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Scripps Clinic, La Jolla, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan H.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Orthopedics, Brown University, Providence, Rhode Island;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Mundis","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Scripps Clinic, La Jolla, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Themistocles S.","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munish C.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank J.","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Northwell Health Lenox Hill, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Francisco Spine Center, San Francisco, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"BMJ Open","first-page":"e023604","article-title":"Association between spinal curvature disorders and injury: a nationwide population-based retrospective cohort study","volume":"9","author":"Kuo YL","year":"2019","unstructured":"Kuo YL, Chung CH, Huang TW,  Association between spinal curvature disorders and injury: a nationwide population-based retrospective cohort study. 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J Spinal Cord Med. 2011;34(6):535\u2013546."},{"issue":"8","key":"b13","series-title":"J Bone Joint Surg Am","first-page":"656","article-title":"Lower extremity motor function following complex adult spinal deformity surgery: two-year follow-up in the Scoli-RISK-1 prospective, multicenter, international study","volume":"100","author":"Lenke LG","year":"2018","unstructured":"Lenke LG, Shaffrey CI, Carreon LY,  Lower extremity motor function following complex adult spinal deformity surgery: two-year follow-up in the Scoli-RISK-1 prospective, multicenter, international study. J Bone Joint Surg Am. 2018;100(8):656\u2013665."},{"key":"b14","series-title":"Clin Orthop Relat Res","first-page":"198","article-title":"Spinal stenosis: surgical versus nonsurgical treatment","volume":"443","author":"Atlas SJ","year":"2006","unstructured":"Atlas SJ, Delitto A. Spinal stenosis: surgical versus nonsurgical treatment. 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