Praveen V Mummaneni1, Paul Park2, Christopher I Shaffrey3, Michael Y Wang4, Juan S Uribe5, Richard G Fessler6, Dean Chou1, Adam S Kanter7, David O Okonkwo7, Gregory M Mundis8, Robert K Eastlack8, Pierce D Nunley9, Neel Anand10, Michael S Virk11, Lawrence G Lenke12, Khoi D Than13, Leslie C Robinson1, Kai-Ming Fu11. 1. 1Department of Neurological Surgery, University of California, San Francisco, California. 2. 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. 3. 3Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia. 4. 4Department of Neurosurgery, University of Miami, Florida. 5. 5Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. 6. 6Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois. 7. 7Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 8. 8Scripps Clinic, La Jolla, California. 9. 9Spine Institute of Louisiana, Shreveport, Louisiana. 10. 10Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California. 11. 11Department of Neurosurgery, Cornell Medical Center, New York, New York. 12. 12Columbia University Medical Center, New York, New York; and. 13. 13Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon.
Abstract
OBJECTIVE: Minimally invasive surgery (MIS) can be used as an alternative or adjunct to traditional open techniques for the treatment of patients with adult spinal deformity. Recent advances in MIS techniques, including advanced anterior approaches, have increased the range of candidates for MIS deformity surgery. The minimally invasive spinal deformity surgery (MISDEF2) algorithm was created to provide an updated framework for decision-making when considering MIS techniques in correction of adult spinal deformity. METHODS: A modified algorithm was developed that incorporates a patient's preoperative radiographic parameters and leads to one of 4 general plans ranging from basic to advanced MIS techniques to open deformity surgery with osteotomies. The authors surveyed 14 fellowship-trained spine surgeons experienced with spinal deformity surgery to validate the algorithm using a set of 24 cases to establish interobserver reliability. They then re-surveyed the same surgeons 2 months later with the same cases presented in a different sequence to establish intraobserver reliability. Responses were collected and analyzed. Correlation values were determined using SPSS software. RESULTS: Over a 3-month period, 14 fellowship-trained deformity surgeons completed the surveys. Responses for MISDEF2 algorithm case review demonstrated an interobserver kappa of 0.85 for the first round of surveys and an interobserver kappa of 0.82 for the second round of surveys, consistent with substantial agreement. In at least 7 cases, there was perfect agreement between the reviewing surgeons. The mean intraobserver kappa for the 2 surveys was 0.8. CONCLUSIONS: The MISDEF2 algorithm was found to have substantial inter- and intraobserver agreement. The MISDEF2 algorithm incorporates recent advances in MIS surgery. The use of the MISDEF2 algorithm provides reliable guidance for surgeons who are considering either an MIS or an open approach for the treatment of patients with adult spinal deformity.
OBJECTIVE: Minimally invasive surgery (MIS) can be used as an alternative or adjunct to traditional open techniques for the treatment of patients with adult spinal deformity. Recent advances in MIS techniques, including advanced anterior approaches, have increased the range of candidates for MIS deformity surgery. The minimally invasive spinal deformity surgery (MISDEF2) algorithm was created to provide an updated framework for decision-making when considering MIS techniques in correction of adult spinal deformity. METHODS: A modified algorithm was developed that incorporates a patient's preoperative radiographic parameters and leads to one of 4 general plans ranging from basic to advanced MIS techniques to open deformity surgery with osteotomies. The authors surveyed 14 fellowship-trained spine surgeons experienced with spinal deformity surgery to validate the algorithm using a set of 24 cases to establish interobserver reliability. They then re-surveyed the same surgeons 2 months later with the same cases presented in a different sequence to establish intraobserver reliability. Responses were collected and analyzed. Correlation values were determined using SPSS software. RESULTS: Over a 3-month period, 14 fellowship-trained deformity surgeons completed the surveys. Responses for MISDEF2 algorithm case review demonstrated an interobserver kappa of 0.85 for the first round of surveys and an interobserver kappa of 0.82 for the second round of surveys, consistent with substantial agreement. In at least 7 cases, there was perfect agreement between the reviewing surgeons. The mean intraobserver kappa for the 2 surveys was 0.8. CONCLUSIONS: The MISDEF2 algorithm was found to have substantial inter- and intraobserver agreement. The MISDEF2 algorithm incorporates recent advances in MIS surgery. The use of the MISDEF2 algorithm provides reliable guidance for surgeons who are considering either an MIS or an open approach for the treatment of patients with adult spinal deformity.