Gregory M Mundis1, Jay D Turner2, Vedat Deverin3, Juan S Uribe4, Pierce Nunley5, Praveen Mummaneni3, Neel Anand6, Paul Park7, David O Okonkwo8, Michael Y Wang9, Shay Bess10, Adam S Kanter8, Richard Fessler11, Stacie Nguyen12, Behrooz A Akbarnia12. 1. San Diego Spine Foundation, 6190 Cornerstone Ct. Suite 212, San Diego, CA 92121, USA; Scripps Clinic, 10666 N Torrey Pines Rd., La Jolla, CA 92036, USA. Electronic address: gmundis1@gmail.com. 2. San Diego Spine Foundation, 6190 Cornerstone Ct. Suite 212, San Diego, CA 92121, USA; Barrow Neurological Institute, 350 W Thomas Rd., Phoenix, AZ 85013, USA. 3. University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94143, USA. 4. University of South Florida, 4202 E Fowler Ave., Tampa, FL 33620, USA. 5. Louisiana Spine Institute, 1500 Line Ave., Shreveport, LA 71101, USA. 6. Cedars-Sinai, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. 7. University of Michigan, 500 S State St., Ann Arbor, MI 48109, USA. 8. University of Pittsburgh Medical Center, 4200 Fifth Ave., Pittsburgh, PA 15260, USA. 9. University of Miami, 3312, 1320 S Dixie Hwy, Coral Gables, FL 33146, USA. 10. NYU Langone Medical Center, 530 1st Ave HCC-110, New York, NY 10016, USA. 11. Rush University, 1653 W Congress Pkwy., Chicago, IL 60612, USA. 12. San Diego Spine Foundation, 6190 Cornerstone Ct. Suite 212, San Diego, CA 92121, USA.
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.
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 ASDpatients. METHODS: A retrospective, multi-center review of ASDpatients (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 ASDpatients 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 ASDpatients with Group 0 and + deformities and improved HRQoL. This study suggests that severe sagittal imbalance is not adequately treated with MIS approaches.
Authors: Jakub Godzik; Bernardo de Andrada Pereira; Courtney Hemphill; Corey T Walker; Joshua T Wewel; Jay D Turner; Juan S Uribe Journal: Global Spine J Date: 2020-05-28