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

  • Original Article - Spine - Other
  • Published:
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Abstract

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.

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Abbreviations

ASD:

Adult spinal deformity

ASA:

American Society of Anesthesia

BMI:

Body mass index

cMIS:

Circumferential MIS

HYB:

Hybrid techniques

IRB:

Institutional Review Board

MCID:

Minimal clinically important difference

MISS:

Minimally invasive spine surgery

MIS-ISSG:

Minimally Invasive Surgery-International Spine Study Group

NIH:

National Institutes of Health

NPS:

Numeric Pain Scores

ODI:

Oswestry Disability Index

PROMs:

Patient reported outcomes measures

PI-LL:

Pelvic incidence-lumbar lordosis

PT:

Pelvic tilt

PJK:

Proximal junctional kyphosis

SVA:

Sagittal vertical axis

SPORT:

Spine Patient Outcomes Research Trial

SD:

Standard deviation

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Funding

No funding was received for this research.

No sources of funding related to this work.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Lois Pope Life Center, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, USA

    Michael Y. Wang & G. Damian Brusko

  2. Department of Neurological Surgery, University of Michigan, Ann Arbor, MI, USA

    Paul Park

  3. Department of Orthopedic Surgery, San Diego Center for Spinal Disorders, La Jolla, CA, USA

    Stacie Tran

  4. Department of Orthopedic Surgery, Cedars Sinai Hospital, Los Angeles, CA, USA

    Neel Anand

  5. Department of Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, LA, USA

    Pierce Nunley

  6. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Adam Kanter

  7. Department of Neurosurgery, Rush University, Chicago, IL, USA

    Richard Fessler

  8. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA

    Juan Uribe

  9. Department of Neurological Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA

    Robert Eastlack

  10. Department of Neurological Surgery, Duke University, Durham, NC, USA

    Christopher I. Shaffrey

  11. Department of Orthopedic Surgery, Denver International Spine Center, Denver, CO, USA

    Shay Bess

  12. Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA

    Gregory M. Mundis Jr

  13. Department of Neurological Surgery, University of California, San Francisco, CA, USA

    Praveen V. Mummaneni

Authors
  1. Michael Y. Wang
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  14. Praveen V. Mummaneni
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Consortia

The MIS-ISSG Group

Corresponding author

Correspondence to Michael Y. Wang.

Ethics declarations

Conflict of interest

Dr. Wang reports royalties from DePuy-Synthes Spine, Inc., Children’s Hospital of Los Angeles, Springer Publishing, and Quality Medical Publishing; grants from the Department of Defense; personal fees from DePuy-Synthes Spine, Inc., Stryker Spine, K2M, and Spineology; advisory board member from Vallum; and stock from Spinicity and Innovative Surgical Devices, outside the submitted work. Dr. Park reports personal fees from Globus, NuVasive, and AlloSource, grants from Pfizer and Vertex, and personal fees from Medtronic, outside the submitted work. Dr. Tran has nothing to disclose. Dr. Anand reports personal fees, royalties, and stocks from Medtronic, royalties and stock from Globus Medical, and stock options from GYS Tech, Paradigm Spine, and TheraCell, and royalties from Elsevier, outside the submitted work. Dr. Nunley reports stock from Amedica Corporation; royalties, speakers bureau, consultant from Zimmer Biomet, and K2M; stock from Paradigm; speakers bureau, consultant, and stock from Spineology; consultant from Vertiflex; royalties, speakers bureau, consultant, and stock from Camber Spine; royalties, consultant from Integrity; consultant from Centinel Spine, outside the submitted work and patents with royalties paid to K2M, and a patent with royalties paid to LDR Medical. Dr. Kanter reports consulting and royalties from NuVasive and Zimmer Biomet, outside the submitted work. Dr. Fessler reports royalties from DePuy-Synthes, outside the submitted work. Dr. Uribe reports research support, stock options, and consulting fees from NuVasive, Inc. and consulting fees from SI-BONE outside of the submitted work. Dr. Eastlack reports personal fees from Globus Medical, NuVasive, and SeaSpine; stock from Invuity; consultant from Aesculap, Baxter, K2M Stryker, NuVasive, SI BONE, and Titan; scientific advisory board from Aesculap; non-financial support from SeaSpine; fellowship support from AO, SeaSpine, and NuVasive; and private investments from NuVasive, SeaSpine, and Alphatec, outside the submitted work. Dr. Shaffrey reports grants from ISSF Foundation during the conduct of the study and personal fees from Medtronic, NuVasive, and Zimmer Biomet, outside the submitted work. Dr. Bess reports grants from NuVasive, K2M, and DePuy Spine; personal fees from ISSG during the conduct of the study; grants from Medtronic, Globus, SI BONE, and Orthofix; and consulting and royalties from K2M, outside the submitted work. Dr. Mundis reports personal fees from NuVasive, K2M, AlloSource, SeaSpine, and Viseon, outside the submitted work, patents from NuVasive with royalties paid, and a patent from K2M with royalties paid. Mr. Brusko has nothing to disclose. Dr. Mummaneni reports personal fees from DePuy Spine, Globus, and Stryker, editorial assistance from ISSG, honoraria from Spineart, royalties from Thieme Publishing and Springer Publishing, grants from NREF, grants from AO Spine, royalties from DePuy Spine, and stock from Spinicity and ISD, outside the submitted work.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

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Wang, M.Y., Park, P., Tran, S. et al. Intermediate-term clinical and radiographic outcomes with less invasive adult spinal deformity surgery: patients with a minimum follow-up of 4 years. Acta Neurochir 162, 1393–1400 (2020). https://doi.org/10.1007/s00701-020-04320-x

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