Postoperative neurological deficits following thoracic decompression surgery: incidence, trajectory, and resolution

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.

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.

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).

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.