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A Critical Analysis of Sagittal Plane Deformity Correction With Minimally Invasive Adult Spinal Deformity Surgery: A 2-Year Follow-Up Study

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Abstract

Introduction

Sagittal plane realignment is important to achieve desirable clinical outcomes after adult spinal deformity (ASD) surgery. This study evaluates the impact of minimally invasive (MIS) techniques on sagittal plane alignment and clinical outcomes in ASD patients.

Methods

A retrospective, multi-center review of ASD patients (age ⩾18 years, and with one of the following: coronal Cobb ⩾20°, sagittal vertical axis [SVA] >5 cm, and/or pelvic tilt >25°), MIS surgery, and four or more levels instrumented. Patients were stratified by baseline SRS-Schwab global alignment modifier (GAM) into three groups: 0 (SVA <4 cm), + (SVA 4–9.5 cm), or ++ (SVA >9.5 cm). Radiographic and clinical outcomes measures were analyzed with a minimum of 2-year follow-up.

Results

A total of 96 ASD patients were identified, and 63 met the study’s inclusion criteria of circumferential MIS or posterior MIS only, with four or more levels instrumented (n: Group 0 = 37, Group + = 15, and Group ++ = 11). Group 0 was younger than ++ (56.8 vs. 69.6 years), with a higher proportion of females than Group + or ++ (83.8% vs. 66.7% and 54.5%, respectively).

Baseline HRQoL was similar. Postoperatively, Groups 0 and + had improved Oswestry Disability Index (ODI) and numeric rating scale (NRS) back and leg scores. Group ++ only had improvement in NRS scores. At the latest follow-up, Groups 0 and ++ had similar sagittal measurements except for PT (21.6 vs. 23.6, p =.009). The + group had improvement in PI–LL (24.2 to 17; p =.015) and LL (30.9 to 38.3; p =.013). Eight of 27 (21.6%) Group 0 patients deteriorated (4 to Group +, 4 to Group ++). Three of 15 (20.0%) Group + patients deteriorated to Group ++, and 3 improved to Group 0. Six of 11 (54.5%) Group ++ patients improved (3 to Group + and 3 to Group 0).

Conclusions

MIS techniques successfully stabilized ASD patients with Group 0 and + deformities and improved HRQoL. This study suggests that severe sagittal imbalance is not adequately treated with MIS approaches.

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Author information

Authors and Affiliations

  1. San Diego Spine Foundation, 6190 Cornerstone Ct. Suite 212, San Diego, CA, 92121, USA

    Gregory M. Mundis Jr. MD, Jay D. Turner MD, PhD, Stacie Nguyen MPH & Behrooz A. Akbarnia MD

  2. Scripps Clinic, 10666 N Torrey Pines Rd., La Jolla, CA, 92036, USA

    Gregory M. Mundis Jr. MD

  3. Barrow Neurological Institute, 350 W Thomas Rd., Phoenix, AZ, 85013, USA

    Jay D. Turner MD, PhD

  4. University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA, 94143, USA

    Vedat Deverin MD & Praveen Mummaneni MD

  5. University of South Florida, 4202 E Fowler Ave., Tampa, FL, 33620, USA

    Juan S. Uribe MD

  6. Louisiana Spine Institute, 1500 Line Ave., Shreveport, LA, 71101, USA

    Pierce Nunley MD

  7. Cedars-Sinai, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA

    Neel Anand MD

  8. University of Michigan, 500 S State St., Ann Arbor, MI, 48109, USA

    Paul Park MD

  9. University of Pittsburgh Medical Center, 4200 Fifth Ave., Pittsburgh, PA, 15260, USA

    David O. Okonkwo MD & Adam S. Kanter MD

  10. University of Miami, 3312, 1320 S Dixie Hwy, Coral Gables, FL, 33146, USA

    Michael Y. Wang MD

  11. NYU Langone Medical Center, 530 1st Ave HCC-110, New York, NY, 10016, USA

    Shay Bess MD

  12. Rush University, 1653 W Congress Pkwy., Chicago, IL, 60612, USA

    Richard Fessler MD, PhD

Authors
  1. Gregory M. Mundis Jr. MD
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  2. Jay D. Turner MD, PhD
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  3. Vedat Deverin MD
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  4. Juan S. Uribe MD
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  6. Praveen Mummaneni MD
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  7. Neel Anand MD
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  9. David O. Okonkwo MD
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  10. Michael Y. Wang MD
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  11. Shay Bess MD
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  14. Stacie Nguyen MPH
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  15. Behrooz A. Akbarnia MD
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International Spine Study Group

Corresponding author

Correspondence to Gregory M. Mundis Jr. MD.

Additional information

Author disclosures

GMM (personal fees from NuVasive, personal fees from K2M, personal fees from DePuy Synthes, outside the submitted work; in addition, GMM has patents K2M and NuVasive with royalties paid); JDT (none); VD (personal fees from NuVasive; grants from Globus, NuVasive, and AO Spine, outside the submitted work); JSU (other from NuVasive, outside the submitted work); PN (personal fees and other from Vertiflex, LDR, Spine, and K2M; personal fees from Osprey Biomedical; other from Amedica, Safewire, Paradigm, and Spineology, outside the submitted work); PM (consultancy fees from DePuy Spine; royalty from DePuy Spine, Taylor and Francis, Thieme, and Springer; honoraria from DePuy Spine, Globus, and AO Spine; Director at Large at Scoliosis Research Society; and stocks in Spinicity/ISD); NA (other from Medtronics, personal fees from Medtronics, other from Globus Medical, other from Elsevier, outside the submitted work; in addition, NA has a patent Medtronics with royalties paid); PP (personal fees from Globus, Biomet, and Medtronic; other from Globus; grants from StemCells and Pfizer, outside the submitted work); DOO (other from Biomet, outside the submitted work); MYW (personal fees from DePuy Spine, Aesculap Spine, Joi- Max, and K2M; grants from Department of Defense, outside the submitted work; in addition, MYW has a patent DePuy Spine with royalties paid); SB (grants and consulting for K2 Medical, NuVasive, and Innovasis and consulting for Allosource; in addition, SB receives royalties from Pioneer, K2 Medical, and Innovasis); ASK (none); Richard Fessler (others from Medtronic, DePuy, Stryker, DePuy, and Benvenue, outside the submitted work; in addition, RF has patents Medtronic, DePuy, and Stryker with royalties paid, and a patent In Queue Innovations pending); SN (none); BAA (grants and personal fees from NuVasive and K2M, personal fees from DePuy Spine and NociMed, outside the submitted work).

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Mundis, G.M., Turner, J.D., Deverin, V. et al. A Critical Analysis of Sagittal Plane Deformity Correction With Minimally Invasive Adult Spinal Deformity Surgery: A 2-Year Follow-Up Study. Spine Deform 5, 265–271 (2017). https://doi.org/10.1016/j.jspd.2017.01.010

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  • DOI: https://doi.org/10.1016/j.jspd.2017.01.010

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