Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery?

Paul Park, David O. Okonkwo, Stacie Nguyen, Gregory M. Mundis, Khoi D. Than, Vedat Deviren, Frank La Marca, Kai Ming Fu, Michael Y. Wang, Juan S. Uribe, Neel Anand, Richard Fessler, Pierce D. Nunley, Dean Chou, Adam S. Kanter, Christopher I. Shaffrey, Behrooz A. Akbarnia, Peter G. Passias, Robert K. Eastlack, Praveen V. Mummaneni

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Older age has been considered a relative contraindication to complex spinal procedures. Minimally invasive surgery (MIS) techniques to treat patients with adult spinal deformity (ASD) have emerged with the potential benefit of decreased approach-related morbidity. Objective: To determine whether a minimal clinically important difference (MCID) could be achieved in patients ages ≥65 years with ASD who underwent MIS. Methods: Multicenter database of patients who underwent MIS for ASD was queried. Outcome metrics assessed were Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for back and leg pain. On the basis of published reports, MCID was defined as a positive change of 12.8 ODI, 1.2 VAS back pain, and 1.6 VAS leg pain. Results: Forty-two patients were identified. Mean age was 70.3 years; 31 (73.8%) were women. Preoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis mismatch, and sagittal vertical axis were 35°, 24.6°, 14.2°, and 4.7 cm, respectively. Postoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis, and sagittal vertical axis were 18°, 25.4°, 11.9°, and 4.9 cm, respectively. A mean of 5.0 levels was treated posteriorly, and a mean of 4.0 interbody fusions was performed. Mean ODI improved from 47.1 to 25.1. Mean VAS back and leg pain scores improved from 6.8 and 5.9 to 2.7 and 2.7, respectively. Mean follow-up was 32.1 months. For ODI, 64.3% of patients achieved MCID. For VAS back and leg pain, 82.9% and 72.2%, respectively, reached MCID. Conclusions: MCID represents the threshold at which patients feel a meaningful clinical improvement has occurred. Our study results suggest that the majority of elderly patients with modest ASD can achieve MCID with MIS.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jul 24 2015
Externally publishedYes

Fingerprint

Minimally Invasive Surgical Procedures
Back Pain
Visual Analog Scale
Leg
Lordosis
Incidence
Pain Measurement
Minimal Clinically Important Difference
Databases
Morbidity

Keywords

  • Adult spinal deformity
  • Elderly
  • Minimally invasive surgery
  • Spine

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery? / Park, Paul; Okonkwo, David O.; Nguyen, Stacie; Mundis, Gregory M.; Than, Khoi D.; Deviren, Vedat; La Marca, Frank; Fu, Kai Ming; Wang, Michael Y.; Uribe, Juan S.; Anand, Neel; Fessler, Richard; Nunley, Pierce D.; Chou, Dean; Kanter, Adam S.; Shaffrey, Christopher I.; Akbarnia, Behrooz A.; Passias, Peter G.; Eastlack, Robert K.; Mummaneni, Praveen V.

In: World Neurosurgery, 24.07.2015.

Research output: Contribution to journalArticle

Park, P, Okonkwo, DO, Nguyen, S, Mundis, GM, Than, KD, Deviren, V, La Marca, F, Fu, KM, Wang, MY, Uribe, JS, Anand, N, Fessler, R, Nunley, PD, Chou, D, Kanter, AS, Shaffrey, CI, Akbarnia, BA, Passias, PG, Eastlack, RK & Mummaneni, PV 2015, 'Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery?', World Neurosurgery. https://doi.org/10.1016/j.wneu.2015.09.072
Park, Paul ; Okonkwo, David O. ; Nguyen, Stacie ; Mundis, Gregory M. ; Than, Khoi D. ; Deviren, Vedat ; La Marca, Frank ; Fu, Kai Ming ; Wang, Michael Y. ; Uribe, Juan S. ; Anand, Neel ; Fessler, Richard ; Nunley, Pierce D. ; Chou, Dean ; Kanter, Adam S. ; Shaffrey, Christopher I. ; Akbarnia, Behrooz A. ; Passias, Peter G. ; Eastlack, Robert K. ; Mummaneni, Praveen V. / Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery?. In: World Neurosurgery. 2015.
@article{f0703e109a2c4d03b94b94364091b36c,
title = "Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery?",
abstract = "Background: Older age has been considered a relative contraindication to complex spinal procedures. Minimally invasive surgery (MIS) techniques to treat patients with adult spinal deformity (ASD) have emerged with the potential benefit of decreased approach-related morbidity. Objective: To determine whether a minimal clinically important difference (MCID) could be achieved in patients ages ≥65 years with ASD who underwent MIS. Methods: Multicenter database of patients who underwent MIS for ASD was queried. Outcome metrics assessed were Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for back and leg pain. On the basis of published reports, MCID was defined as a positive change of 12.8 ODI, 1.2 VAS back pain, and 1.6 VAS leg pain. Results: Forty-two patients were identified. Mean age was 70.3 years; 31 (73.8{\%}) were women. Preoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis mismatch, and sagittal vertical axis were 35°, 24.6°, 14.2°, and 4.7 cm, respectively. Postoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis, and sagittal vertical axis were 18°, 25.4°, 11.9°, and 4.9 cm, respectively. A mean of 5.0 levels was treated posteriorly, and a mean of 4.0 interbody fusions was performed. Mean ODI improved from 47.1 to 25.1. Mean VAS back and leg pain scores improved from 6.8 and 5.9 to 2.7 and 2.7, respectively. Mean follow-up was 32.1 months. For ODI, 64.3{\%} of patients achieved MCID. For VAS back and leg pain, 82.9{\%} and 72.2{\%}, respectively, reached MCID. Conclusions: MCID represents the threshold at which patients feel a meaningful clinical improvement has occurred. Our study results suggest that the majority of elderly patients with modest ASD can achieve MCID with MIS.",
keywords = "Adult spinal deformity, Elderly, Minimally invasive surgery, Spine",
author = "Paul Park and Okonkwo, {David O.} and Stacie Nguyen and Mundis, {Gregory M.} and Than, {Khoi D.} and Vedat Deviren and {La Marca}, Frank and Fu, {Kai Ming} and Wang, {Michael Y.} and Uribe, {Juan S.} and Neel Anand and Richard Fessler and Nunley, {Pierce D.} and Dean Chou and Kanter, {Adam S.} and Shaffrey, {Christopher I.} and Akbarnia, {Behrooz A.} and Passias, {Peter G.} and Eastlack, {Robert K.} and Mummaneni, {Praveen V.}",
year = "2015",
month = "7",
day = "24",
doi = "10.1016/j.wneu.2015.09.072",
language = "English (US)",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery?

AU - Park, Paul

AU - Okonkwo, David O.

AU - Nguyen, Stacie

AU - Mundis, Gregory M.

AU - Than, Khoi D.

AU - Deviren, Vedat

AU - La Marca, Frank

AU - Fu, Kai Ming

AU - Wang, Michael Y.

AU - Uribe, Juan S.

AU - Anand, Neel

AU - Fessler, Richard

AU - Nunley, Pierce D.

AU - Chou, Dean

AU - Kanter, Adam S.

AU - Shaffrey, Christopher I.

AU - Akbarnia, Behrooz A.

AU - Passias, Peter G.

AU - Eastlack, Robert K.

AU - Mummaneni, Praveen V.

PY - 2015/7/24

Y1 - 2015/7/24

N2 - Background: Older age has been considered a relative contraindication to complex spinal procedures. Minimally invasive surgery (MIS) techniques to treat patients with adult spinal deformity (ASD) have emerged with the potential benefit of decreased approach-related morbidity. Objective: To determine whether a minimal clinically important difference (MCID) could be achieved in patients ages ≥65 years with ASD who underwent MIS. Methods: Multicenter database of patients who underwent MIS for ASD was queried. Outcome metrics assessed were Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for back and leg pain. On the basis of published reports, MCID was defined as a positive change of 12.8 ODI, 1.2 VAS back pain, and 1.6 VAS leg pain. Results: Forty-two patients were identified. Mean age was 70.3 years; 31 (73.8%) were women. Preoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis mismatch, and sagittal vertical axis were 35°, 24.6°, 14.2°, and 4.7 cm, respectively. Postoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis, and sagittal vertical axis were 18°, 25.4°, 11.9°, and 4.9 cm, respectively. A mean of 5.0 levels was treated posteriorly, and a mean of 4.0 interbody fusions was performed. Mean ODI improved from 47.1 to 25.1. Mean VAS back and leg pain scores improved from 6.8 and 5.9 to 2.7 and 2.7, respectively. Mean follow-up was 32.1 months. For ODI, 64.3% of patients achieved MCID. For VAS back and leg pain, 82.9% and 72.2%, respectively, reached MCID. Conclusions: MCID represents the threshold at which patients feel a meaningful clinical improvement has occurred. Our study results suggest that the majority of elderly patients with modest ASD can achieve MCID with MIS.

AB - Background: Older age has been considered a relative contraindication to complex spinal procedures. Minimally invasive surgery (MIS) techniques to treat patients with adult spinal deformity (ASD) have emerged with the potential benefit of decreased approach-related morbidity. Objective: To determine whether a minimal clinically important difference (MCID) could be achieved in patients ages ≥65 years with ASD who underwent MIS. Methods: Multicenter database of patients who underwent MIS for ASD was queried. Outcome metrics assessed were Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for back and leg pain. On the basis of published reports, MCID was defined as a positive change of 12.8 ODI, 1.2 VAS back pain, and 1.6 VAS leg pain. Results: Forty-two patients were identified. Mean age was 70.3 years; 31 (73.8%) were women. Preoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis mismatch, and sagittal vertical axis were 35°, 24.6°, 14.2°, and 4.7 cm, respectively. Postoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis, and sagittal vertical axis were 18°, 25.4°, 11.9°, and 4.9 cm, respectively. A mean of 5.0 levels was treated posteriorly, and a mean of 4.0 interbody fusions was performed. Mean ODI improved from 47.1 to 25.1. Mean VAS back and leg pain scores improved from 6.8 and 5.9 to 2.7 and 2.7, respectively. Mean follow-up was 32.1 months. For ODI, 64.3% of patients achieved MCID. For VAS back and leg pain, 82.9% and 72.2%, respectively, reached MCID. Conclusions: MCID represents the threshold at which patients feel a meaningful clinical improvement has occurred. Our study results suggest that the majority of elderly patients with modest ASD can achieve MCID with MIS.

KW - Adult spinal deformity

KW - Elderly

KW - Minimally invasive surgery

KW - Spine

UR - http://www.scopus.com/inward/record.url?scp=84950244124&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84950244124&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2015.09.072

DO - 10.1016/j.wneu.2015.09.072

M3 - Article

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -