{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:25:30Z","timestamp":1760243130278,"version":"build-2065373602"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2015,10,12]],"date-time":"2015-10-12T00:00:00Z","timestamp":1444608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objectives: This study aimed to investigate the long-term risk of stroke in adult patients with spinal deformity. Specifically, the study addressed the possible protective effect of surgery for spinal deformity against stroke. Methods: Using the National Health Insurance Research Database (NHIRD), a monopolistic national database in Taiwan, this retrospective cohort study analyzed the incidence of stroke in patients with adult spinal deformity (ASD) in a 11-year period. A total of 13,503 patients, between 55 and 75 years old, were identified for the diagnosis of ASD. The patients were grouped into two: the surgical group (n = 10,439) who received spinal fusion surgery, and the control group (n = 2124) who received other medical treatment. The incidence rates of all subsequent cerebrovascular accidents, including ischemic and hemorrhagic strokes, were calculated. Hazard ratios for stroke were calculated use a full cohort and a propensity score matched cohort. Adjustments for co-morbidities that may predispose to stroke, including hypertension, diabetes mellitus, arrhythmia and coronary heart disease were conducted. Kaplan-Meier and Cox regression analyses were performed to compare the risk of stroke between the two groups. Results: During the total observation period of 50,450 person-years, the incidence rate of stroke in the surgical group (15.55 per 1000 person-years) was significantly lower than that of the control group (20.89 per 1000 person-years, p &lt; 0.001). Stroke was more likely to occur in the control group than in the surgical group (crude hazard ratio 1.34, p &lt; 0.001; adjusted HR 1.28, p &lt; 0.001, by a propensity score matched model). Conclusions: In this national cohort of more than 13,000 ASD patients covering 10 years, stroke was approximately 25% less likely to happen in patients who underwent spinal fusion surgery than those who received medical management. Therefore, spinal fusion surgery may provide a protective effect against stroke in adult patients with spinal deformity.<\/jats:p>","DOI":"10.3390\/ijerph121012618","type":"journal-article","created":{"date-parts":[[2015,10,14]],"date-time":"2015-10-14T02:36:30Z","timestamp":1444790190000},"page":"12618-12627","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Lower Risk of Stroke after Deformity Surgery: Long Term Benefit Demonstrated by a National Cohort Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Liang-Chung","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wu-Fu","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shih-Wei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng-Yuan","family":"Chang","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Fu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan"},{"name":"School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6996-3409","authenticated-orcid":false,"given":"Jau-Ching","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4124-1949","authenticated-orcid":false,"given":"Yu-Chun","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"},{"name":"Department of Medical Research and Education, National Yang-Ming University Hospital,  I-Lan 260, Taiwan"},{"name":"Institute of Hospital and Health Care Administration, School of Medicine,  National Yang-Ming University, Taipei 260, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Cheng","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrich","family":"Cheng","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"},{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan"},{"name":"Institute of Pharmacology, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su-Shun","family":"Lo","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2015,10,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Dorward, I.G., and Lenke, L.G. (2010). Osteotomies in the posterior-only treatment of complex adult spinal deformity: A comparative review. Neurosurg. Focus, 28.","DOI":"10.3171\/2009.12.FOCUS09259"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s11999-009-1037-x","article-title":"Vertebral column resection for the treatment of severe spinal deformity","volume":"468","author":"Lenke","year":"2010","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Upadhyaya, C.D., Starr, P.A., and Mummaneni, P.V. (2010). Spinal deformity and Parkinson disease: A treatment algorithm. Neurosurg. Focus, 28.","DOI":"10.3171\/2010.1.FOCUS09288"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Wang, M.Y., and Mummaneni, P.V. (2010). Minimally invasive surgery for thoracolumbar spinal deformity: Initial clinical experience with clinical and radiographic outcomes. Neurosurg. Focus, 28.","DOI":"10.3171\/2010.1.FOCUS09286"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Yadla, S., Maltenfort, M.G., Ratliff, J.K., and Harrop, J.S. (2010). Adult scoliosis surgery outcomes: A systematic review. Neurosurg. Focus, 28.","DOI":"10.3171\/2009.12.FOCUS09254"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1093\/bmb\/ldp028","article-title":"Global and regional causes of death","volume":"92","author":"Mathers","year":"2009","journal-title":"Brit. Med. Bull."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1007\/s00586-013-2678-8","article-title":"Degenerative lumbar scoliosis in Chinese Han population: Prevalence and relationship to age, gender, bone mineral density, and body mass index","volume":"22","author":"Xu","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1097\/BRS.0b013e31820110b4","article-title":"Characterization of osteopenia\/osteoporosis in adult scoliosis: Does bone density affect surgical outcome?","volume":"36","author":"Yagi","year":"2011","journal-title":"Spine"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Wu, C.L., Wu, J.C., Huang, W.C., Wu, H.T., Chiou, H.J., Liu, L., Chen, Y.C., Chen, T.J., Cheng, H., and Chang, C.Y. (2012). The risk of stroke after percutaneous vertebroplasty for osteoporosis: A population-based cohort study. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0031405"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.spinee.2012.05.008","article-title":"The risk of stroke after spinal fusion surgery: A national cohort study","volume":"12","author":"Wu","year":"2012","journal-title":"Spine J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2680","DOI":"10.1007\/s00586-012-2405-x","article-title":"Lumbar spine fusion surgery and stroke: A national cohort study","volume":"21","author":"Wu","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1161\/01.STR.29.10.2049","article-title":"Physical activity and stroke incidence: The Harvard alumni health study","volume":"29","author":"Lee","year":"1998","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1136\/bmj.304.6827.597","article-title":"Physical activity and stroke in British middle aged men","volume":"304","author":"Wannamethee","year":"1992","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1093\/ije\/dyh168","article-title":"Physical activity and stroke. A meta-analysis of observational data","volume":"33","author":"Schuit","year":"2004","journal-title":"Int. J. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1161\/01.STR.0000091843.02517.9D","article-title":"Physical activity and stroke risk: A meta-analysis","volume":"34","author":"Lee","year":"2003","journal-title":"Stroke"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2961","DOI":"10.1001\/jama.283.22.2961","article-title":"Physical activity and risk of stroke in women","volume":"283","author":"Hu","year":"2000","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1161\/STROKEAHA.110.584300","article-title":"Physical activity and risk of stroke in women","volume":"41","author":"Sattelmair","year":"2010","journal-title":"Stroke"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"987","DOI":"10.7326\/0003-4819-130-12-199906150-00006","article-title":"Effects of leisure-time physical activity and ventilatory function on risk for stroke in men: The Reykjavik study","volume":"130","author":"Agnarsson","year":"1999","journal-title":"Ann. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.1161\/01.STR.0000177868.89946.0c","article-title":"Leisure time, occupational, and commuting physical activity and the risk of stroke","volume":"36","author":"Hu","year":"2005","journal-title":"Stroke"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1161\/01.STR.0000223048.70103.F1","article-title":"Primary prevention of ischemic stroke: A guideline from the American Heart Association\/American Stroke Association Stroke Council","volume":"37","author":"Goldstein","year":"2006","journal-title":"Stroke"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1161\/STR.0b013e3181fcb238","article-title":"Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"42","author":"Goldstein","year":"2011","journal-title":"Stroke"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/12\/10\/12618\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T20:49:55Z","timestamp":1760215795000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/12\/10\/12618"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,12]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2015,10]]}},"alternative-id":["ijerph121012618"],"URL":"https:\/\/doi.org\/10.3390\/ijerph121012618","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2015,10,12]]}}}