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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

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Abstract

Study Design

Retrospective.

Objectives

Compare circumferential minimally invasive surgical (CMIS) correction outcomes of patients treated for adult spinal deformity (ASD) with a newer versus older protocol

Summary of Background Data

CMIS techniques have become increasingly popular. Increasing experience and learning curve may help improve outcomes.

Methods

A 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.

Results

The 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).

Conclusion

Improvements 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 Evidence

Level IV.

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Abbreviations

CMIS:

circumferential minimally invasive surgery

ASD:

adult spinal deformity

SVA:

sagittal vertical axis

PI-LL mismatch:

pelvic incidence-lumbar lordosis mismatch

SD:

standard deviation

VAS:

visual analog scale

ODI:

Oswestry disability index

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, Cedars-Sinai Spine Center, 444 S. San Vicente Blvd., Suite 800, Los Angeles, CA, 90048, USA

    Neel Anand MD

  2. Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY, 10461, USA

    Jason Ezra Cohen BS

  3. Boston University School of Medicine, 72 E Concord St., Boston, MA, 02118, USA

    Ryan Baruch Cohen BS

  4. Cedars-Sinai Spine Center, 444 S. San Vicente Blvd., Suite 800, Los Angeles, CA, 90048, USA

    Babak Khandehroo MD & Sheila Kahwaty PA-C

  5. Department of Neurosurgery, Cedars-Sinai Spine Center, 444 S. San Vicente Blvd., Suite 800, Los Angeles, CA, 90048, USA

    Eli Baron MD

Authors
  1. Neel Anand MD
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  2. Jason Ezra Cohen BS
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  4. Babak Khandehroo MD
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  5. Sheila Kahwaty PA-C
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  6. Eli Baron MD
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Corresponding author

Correspondence to Neel Anand MD.

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Author disclosures

NA (other from Globus Medical, Theracell, Medtronic, DePuy Synthes, Stryker Spine, Paradigm Spine, NuVasive, and Elsevier, outside the submitted work); JEC (none); RBC (none); BK (none); SK (none); EB (other from Elsevier and McGraw-Hill, outside the submitted work).

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Anand, N., Cohen, J.E., Cohen, R.B. et al. 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. Spine Deform 5, 213–223 (2017). https://doi.org/10.1016/j.jspd.2016.12.005

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