Neurovascular Outcomes in Adults Undergoing Surgery for Spinal Deformities: A Narrative Review

Abstract Background: Neuromuscular spinal deformities in adults are increasingly recognised due to improved survival among individuals with chronic neurological and neuromuscular disorders. Surgical correction may enhance function, sitting balance, and quality of life, but carries significant perioperative risk, particularly neurological and cerebrovascular complications. Objective: To provide a narrative review of neurological outcomes and cerebrovascular complications in adults undergoing surgery for neuromuscular spinal deformities, and to identify key risk factors and clinical implications. Methodology: A narrative review of the literature was conducted using published studies on adult spinal deformity (ASD), and neuromuscular scoliosis. Evidence from cohort studies, registry data, and relevant reviews were examined to characterise neurological complications, cerebrovascular events, and associated risk factors, with emphasis placed on adult populations, perioperative mechanisms, and patterns of reported outcomes. Results: Neurological complications were variably reported, with incidence in ASD literature ranging from approximately 2% to 10%, increasing in complex procedures. Risk was associated with operative factors and patient frailty. Cerebrovascular complications were rare, typically <1%, but carried significant morbidity. Heterogeneity and inconsistent reporting precluded precise incidence estimates in adult neuromuscular populations. Conclusion: Neurological complications remain a major concern in adult neuromuscular spinal deformity surgery, while cerebrovascular events, although rare, are clinically significant and likely underreported. Multidisciplinary optimisation, careful patient selection, and intraoperative neuromonitoring are essential to improving outcomes.