Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery?

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Park, Paul
Okonkwo, David O
Nguyen, Stacie
Mundis, Gregory M
Than, Khoi D
Deviren, Vedat
La Marca, Frank
Fu, Kai-Ming
Wang, Michael Y
Uribe, Juan S

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Older age has been considered a relative contraindication to complex spinal procedures. Minimally invasive surgery (MIS) techniques to treat patients with adult spinal deformity (ASD) have emerged with the potential benefit of decreased approach-related morbidity.


To determine whether a minimal clinically important difference (MCID) could be achieved in patients ages ≥ 65 years with ASD who underwent MIS.


Multicenter database of patients who underwent MIS for ASD was queried. Outcome metrics assessed were Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for back and leg pain. On the basis of published reports, MCID was defined as a positive change of 12.8 ODI, 1.2 VAS back pain, and 1.6 VAS leg pain.


Forty-two patients were identified. Mean age was 70.3 years; 31 (73.8%) were women. Preoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis mismatch, and sagittal vertical axis were 35°, 24.6°, 14.2°, and 4.7 cm, respectively. Postoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis, and sagittal vertical axis were 18°, 25.4°, 11.9°, and 4.9 cm, respectively. A mean of 5.0 levels was treated posteriorly, and a mean of 4.0 interbody fusions was performed. Mean ODI improved from 47.1 to 25.1. Mean VAS back and leg pain scores improved from 6.8 and 5.9 to 2.7 and 2.7, respectively. Mean follow-up was 32.1 months. For ODI, 64.3% of patients achieved MCID. For VAS back and leg pain, 82.9% and 72.2%, respectively, reached MCID.


MCID represents the threshold at which patients feel a meaningful clinical improvement has occurred. Our study results suggest that the majority of elderly patients with modest ASD can achieve MCID with MIS.





International Spine Study Group, Lumbar Vertebrae, Sacrum, Humans, Spinal Curvatures, Back Pain, Radiography, Treatment Outcome, Spinal Fusion, Cohort Studies, Age Factors, Recovery of Function, Databases, Factual, Aged, Female, Male, Minimally Invasive Surgical Procedures


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Park, Paul, David O Okonkwo, Stacie Nguyen, Gregory M Mundis, Khoi D Than, Vedat Deviren, Frank La Marca, Kai-Ming Fu, et al. (2016). Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery?. World neurosurgery, 86. pp. 168–172. 10.1016/j.wneu.2015.09.072 Retrieved from

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Khoi Duc Than

Professor of Neurosurgery

I chose to pursue neurosurgery as a career because of my fascination with the human nervous system. In medical school, I developed a keen interest in the diseases that afflict the brain and spine and gravitated towards the only field where I could help treat these diseases with my own hands. I focus on disorders of the spine where my first goal is to help patients avoid surgery if at all possible. If surgery is needed, I treat patients using the most advanced minimally invasive techniques available in order to minimize pain, blood loss, and hospital stay, while maximizing recovery, neurologic function, and quality of life. In my free time, I enjoy spending time with my family and friends. I am an avid sports fan and love to eat. I try to stay physically fit by going to the gym and playing ice hockey.


Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.

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