Intermediate-term clinical and radiographic outcomes with less invasive adult spinal deformity surgery: patients with a minimum follow-up of 4 years.

Wang, Michael Y

Park, Paul

Tran, Stacie

Anand, Neel

Nunley, Pierce

Kanter, Adam

Fessler, Richard

Uribe, Juan

Eastlack, Robert

Shaffrey, Christopher I

Bess, Shay

Mundis, Gregory M

Brusko, G Damian

Mummaneni, Praveen V

MIS-ISSG Group

2020-05-01T13:41:39Z

2020-05-01T13:41:39Z

2020-04-14

2020-05-01T13:41:38Z

BACKGROUND: Little information exists regarding longer-term outcomes with minimally invasive spine surgery (MISS), particularly regarding long-segment and deformity procedures. We aimed to evaluate intermediate-term outcomes of MISS for adult spinal deformity (ASD). METHODS: This retrospective review of a prospectively collected multicenter database examined outcomes at 4 or more years following circumferential MIS (cMIS) or hybrid (HYB) surgery for ASD. A total of 53 patients at 8 academic centers satisfied the following inclusion criteria: age > 18 years and coronal Cobb > 20°, pelvic incidence-lumbar lordosis (PI-LL) > 10°, or sagittal vertical axis (SVA) > 5 cm. RESULTS: Radiographic outcomes demonstrated improvements of PI-LL from 16.8° preoperatively to 10.8° and coronal Cobb angle from 38° preoperatively to 18.2° at 4 years. The incidence of complications over the follow-up period was 56.6%. A total of 21 (39.6%) patients underwent reoperation in the thoracolumbar spine, most commonly for adjacent level disease or proximal junctional kyphosis, which occurred in 11 (20.8%) patients. Mean Oswestry Disability Index (ODI) at baseline and years 1 through 4 were 49.9, 33.1, 30.2, 32.7, and 35.0, respectively. The percentage of patients meeting minimal clinically important difference (MCID) (defined as 12% or more from baseline) decreased over time, with leg pain reduction more durable than back pain reduction. CONCLUSIONS: Intermediate-term clinical and radiographic improvement following MISS for ASD is sustained, but extent of improvement lessens over time. Outcome variability exists within a subset of patients not meeting MCID, which increases over time after year two. Loss of improvement over time was more notable in back than leg pain. However, average ODI improvement meets MCID at 4 years after MIS ASD surgery.

10.1007/s00701-020-04320-x

0001-6268

0942-0940

https://hdl.handle.net/10161/20579

eng

Springer Science and Business Media LLC

Acta Neurochir (Wien)

10.1007/s00701-020-04320-x

Long-term follow-up

Minimally invasive

Patient reported outcomes measures (PROMs)

Spinal deformity

Intermediate-term clinical and radiographic outcomes with less invasive adult spinal deformity surgery: patients with a minimum follow-up of 4 years.

Journal article

Shaffrey, Christopher I|0000-0001-9760-8386

School of Medicine

Orthopaedics

Neurosurgery

Duke

Clinical Science Departments

Published online