Comparison of a Newer Versus Older Protocol for Circumferential Minimally Invasive Surgical (CMIS) Correction of Adult Spinal Deformity (ASD)—Evolution Over a 10-Year Experience

Publication date: May 2017
Source:Spine Deformity, Volume 5, Issue 3
Author(s): Neel Anand, Jason Ezra Cohen, Ryan Baruch Cohen, Babak Khandehroo, Sheila Kahwaty, Eli Baron
Study DesignRetrospective.ObjectivesCompare circumferential minimally invasive surgical (CMIS) correction outcomes of patients treated for adult spinal deformity (ASD) with a newer versus older protocolSummary of Background DataCMIS techniques have become increasingly popular. Increasing experience and learning curve may help improve outcomes.MethodsA prospectively collected database was queried for all patients who underwent CMIS correction of ASD (Cobb angle >20° or sagittal vertical axis [SVA] >50 mm or pelvic incidence–lumbar lordosis mismatch >10) at 3+ levels. Those without a full-length radiograph or 2-year follow-up were excluded. Patients were compared based on treatment using our original or newer protocol.ResultsThe original protocol had 76 patients with an average age of 66.99 years (range 46–81, standard deviation [SD] 9.03), and the new protocol had 53 patients with average age of 65.85 years (range 48–85, SD 8.08). Preoperative and latest visual analog scale (VAS) scores in the original were 6.85 and 3.45 (p = .001) and in the new were 6.19 and 2.27 (p = .004). Delta-VAS scores were 3.27 and 4.27. The Oswestry disability index (ODI) reduced from 45.84 to 32.91 (p = .041) in the original and from 44.21 to 25.39 (p = .017) in the new. Average delta-ODIs were 22.25 and 24.01. Preoperative, latest, and delta-SF physical component scores for the original were 35.38, 42.42, and 10.06 and for the new, 30.89, 39.49, and 11.93. SF mental component scores were 50.96, 55.19, and 12.84 and 50.12, 52.99, and 8.85. The original and new protocols had latest Cobb angles of 11.54° and 11.12° (p = .789), delta-Cobb angles of 14.51° and 20.03° (p < .05), latest SVAs of 42.85 and 30.58 mm (p < .05) and latest PI–LL mismatch of 15.49 and 9.00 mm (p < .05). In the original and the new, the average preoperative SVAs that reliably achieved a postoperative SVA of 50 mm or less were 84 and 119 mm, respectively, and the maximum delta-SVAs were 89 and 120 mm. The new protocol had fewer surgical complications (p < .05).ConclusionImprovements in radiographic scores, functional outcomes, and limits of SVA correction and lower complication rates suggest that the new protocol may help improve outcomes. These findings may be a reflection of our 10-year experience and advances in the learning curve.Level of EvidenceLevel IV.



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