TY - JOUR
T1 - Two- and three-year outcomes of minimally invasive and hybrid correction of adult spinal deformity
AU - International Spine Study Group
AU - Chan, Andrew K.
AU - Eastlack, Robert K.
AU - Fessler, Richard G.
AU - Than, Khoi D.
AU - Chou, Dean
AU - Fu, Kai Ming
AU - Park, Paul
AU - Wang, Michael Y.
AU - Kanter, Adam S.
AU - Okonkwo, David O.
AU - Nunley, Pierce D.
AU - Anand, Neel
AU - Uribe, Juan S.
AU - Mundis, Gregory M.
AU - Bess, Shay
AU - Shaffrey, Christopher I.
AU - Le, Vivian P.
AU - Mummaneni, Praveen V.
N1 - Funding Information:
Orthofix Medical Inc. Dr. Eastlack reports direct stock ownership in SI Bone, SeaSpine, Alphatec, NuVasive, and Spine Innovation; being a consultant to Spinal Elements, Aesculap, NuVasive, SeaSpine, SI Bone, Baxter, Stryker, Carevature, and Medtronic; being a patent holder for NuTech, Globus, Seaspine, SI Bone, Spine Innovation, and Stryker; being on the speakers bureau for Radius; receiving royalties from Globus, SI Bone, SeaSpine, Aesculap, and NuVasive; and receiving support of non–study-related clinical or research effort from SeaSpine, NuVasive, Medtronic, and SI Bone. Dr. Fessler reports royalties from DePuy-Synthes, outside the submitted work. Dr. Than reports being a consultant to Bioventus, Integrity Implants, and DePuy-Synthes, and receiving honoraria from LifeNet Health and DJO. Dr. Chou reports being a consultant to Globus and Medtronic, and receiving royalties from Globus. Dr. Fu reports being a consultant to DePuy-Synthes, Globus, Johnson & Johnson, SI Bone, and Atlas Spine. Dr. Park reports being a consultant to Globus and NuVasive, receiving royalties from Globus, receiving honorarium from Depuy, and receiving support of non–study-related clinical or research effort from DePuy, ISSG, SI Bone, and Cerapedics. Dr. Wang reports being a consultant for DePuy-Synthes, Spineology, Medtronic, Globus, and Stryker; being a patent holder for DePuy-Synthes; having direct stock ownership in ISD, Kinesiometrics, and Medical Device Partners; receiving royalties from DePuy-Synthes Spine, Children’s Hospital of Los Angeles, Springer Publishing, and Quality Medical Publishing; receiving grants from the Department of Defense; receiving personal fees from DePuy-Synthes Spine, Stryker Spine, K2M, and Spineology; being an advisory board member for Vallum; and owning stock in Spinicity and Innovative Surgical Devices, outside the submitted work. Dr. Kanter reports receiving royalties from NuVasive and Zimmer Biomet; being a consultant for NuVasive; and being a patent holder for Zimmer Biomet. Dr. Okonkwo reports receiving royalties from and being a consultant to NuVasive and Zimmer Biomet, and being a patent holder for Zimmer Biomet. Dr. Nunley reports royalties from Spineology Inc., Stryker, Zimmer, Camber Spine/ IMSE, and Accelus; being on the speakers bureau for Spineology Inc., Zimmer, Camber Spine/IMSE, Instrinisic Therapeutics, Providence Medical, and Neo Spine; being a consultant for Spineology Inc., Stryker, Zimmer, Camber Spine/IMSE, Accelus, Centinel Spine, Instrinisic Therapeutics, Providence Medical, Neo Spine, NG Medical, and Regeltec; receving research support from Spineology Inc., Centinel Spine, Providence Medical, NuVasive, and Surgalign; and receiving stock/stock options in Spineology Inc., Camber Spine/IMSE, Regeltec, and Surgalign. Dr. Anand reports being a consultant to Medtronic, DePuy-Synthes, Spinal Balance, Spinal Simplicity, and Viseon; receiving royalties from Medtronic, Globus Medical, and Elsevier; being a patent holder for Medtronic; and having direct stock ownership in Globus Medical, Atlas Spine, Paradigm Spine, Spinal Balance, Spinal Simplicity, Viseon, and Theracell. Dr. Uribe reports being a consultant to NuVasive, SI Bone, Misonix, and Mainstay. Dr. Mundis reports being a consultant to NuVasive, Viseon, SeaSpine, and Carlsmed; having direct stock ownership in NuVasive, Viseon, SeaSpine, Alphatec, and Suralign; being a patent holder for K2M; and receiving royalties from NuVasive, Stryker, and K2M. Dr. Bess reports grants to the ISSG from Stryker, NuVasive, ISSGF, Globus, Medtronic, SI Bone, SEA Spine, and DePuy-Synthes; and receiving royalties from Stryker and NuVasive. Dr. Shaffrey reports direct stock ownership in NuVasive; being a consultant to NuVasive, Medtronic, and SI Bone; receiving royalties from NuVasive, Medtronic, and Zimmer Biomet; and being a patent holder for NuVasive, Medtronic, and Zimmer Biomet. Dr. Mummaneni reports being a consultant to Stryker Spine, DePuy Synthes, and Globus; having direct stock ownership in Spinicity/ISD; receiving statistical analysis for study/writing or editorial assistance on the manuscript from ISSG; receiving royalties from DePuy-Synthes, Thieme Publishers, and Springer Publishers; and receiving support of non–study-related clinical or research effort from AO Spine and NREF.
Publisher Copyright:
© 2022 AANS.
PY - 2022/4
Y1 - 2022/4
N2 - Objective: Previous studies have demonstrated the short-term radiographic and clinical benefits of circumferential minimally invasive surgery (cMIS) and hybrid (i.e., minimally invasive anterior or lateral interbody fusion with an open posterior approach) techniques to correct adult spinal deformity (ASD). However, it is not known if these benefits are maintained over longer periods of time. This study evaluated the 2- and 3-year outcomes of cMIS and hybrid correction of ASD. Methods: A multicenter database was retrospectively reviewed for patients undergoing cMIS or hybrid surgery for ASD. Patients were ≥ 18 years of age and had one of the following: maximum coronal Cobb angle (CC) ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic incidence-lumbar lordosis mismatch (PI-LL) ≥ 10°, or pelvic tilt (PT) > 20°. Radiographic parameters were evaluated at the latest follow-up. Clinical outcomes were compared at 2- and 3-year time points and adjusted for age, preoperative CC, levels operated, levels with interbody fusion, presence of L5-S1 anterior lumbar interbody fusion, and upper and lower instrumented vertebral level. Results: Overall, 197 (108 cMIS, 89 hybrid) patients were included with 187 (99 cMIS, 88 hybrid) and 111 (60 cMIS, 51 hybrid) patients evaluated at 2 and 3 years, respectively. The mean (± SD) follow-up duration for cMIS (39.0 ± 13.3 months, range 22-74 months) and hybrid correction (39.9 ± 16.8 months, range 22-94 months) were similar for both cohorts. Hybrid procedures corrected the CC greater than the cMIS technique (adjusted p = 0.022). There were no significant differences in postoperative SVA, PI-LL, PT, and sacral slope (SS). At 2 years, cMIS had lower Oswestry Disability Index (ODI) scores (adjusted p < 0.001), greater ODI change as a percentage of baseline (adjusted p = 0.006), less visual analog scale (VAS) back pain (adjusted p = 0.006), and greater VAS back pain change as a percentage of baseline (adjusted p = 0.001) compared to hybrid techniques. These differences were no longer significant at 3 years. At 3 years, but not 2 years, VAS leg pain was lower for cMIS compared to hybrid techniques (adjusted p = 0.032). Those undergoing cMIS had fewer overall complications compared to hybrid techniques (adjusted p = 0.006), but a higher odds of pseudarthrosis (adjusted p = 0.039). Conclusions: In this review of a multicenter database for patients undergoing cMIS and hybrid surgery for ASD, hybrid procedures were associated with a greater CC improvement compared to cMIS techniques. cMIS was associated with superior ODI and back pain at 2 years, but this difference was no longer evident at 3 years. However, cMIS was associated with superior leg pain at 3 years. There were fewer complications following cMIS, with the exception of pseudarthrosis.
AB - Objective: Previous studies have demonstrated the short-term radiographic and clinical benefits of circumferential minimally invasive surgery (cMIS) and hybrid (i.e., minimally invasive anterior or lateral interbody fusion with an open posterior approach) techniques to correct adult spinal deformity (ASD). However, it is not known if these benefits are maintained over longer periods of time. This study evaluated the 2- and 3-year outcomes of cMIS and hybrid correction of ASD. Methods: A multicenter database was retrospectively reviewed for patients undergoing cMIS or hybrid surgery for ASD. Patients were ≥ 18 years of age and had one of the following: maximum coronal Cobb angle (CC) ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic incidence-lumbar lordosis mismatch (PI-LL) ≥ 10°, or pelvic tilt (PT) > 20°. Radiographic parameters were evaluated at the latest follow-up. Clinical outcomes were compared at 2- and 3-year time points and adjusted for age, preoperative CC, levels operated, levels with interbody fusion, presence of L5-S1 anterior lumbar interbody fusion, and upper and lower instrumented vertebral level. Results: Overall, 197 (108 cMIS, 89 hybrid) patients were included with 187 (99 cMIS, 88 hybrid) and 111 (60 cMIS, 51 hybrid) patients evaluated at 2 and 3 years, respectively. The mean (± SD) follow-up duration for cMIS (39.0 ± 13.3 months, range 22-74 months) and hybrid correction (39.9 ± 16.8 months, range 22-94 months) were similar for both cohorts. Hybrid procedures corrected the CC greater than the cMIS technique (adjusted p = 0.022). There were no significant differences in postoperative SVA, PI-LL, PT, and sacral slope (SS). At 2 years, cMIS had lower Oswestry Disability Index (ODI) scores (adjusted p < 0.001), greater ODI change as a percentage of baseline (adjusted p = 0.006), less visual analog scale (VAS) back pain (adjusted p = 0.006), and greater VAS back pain change as a percentage of baseline (adjusted p = 0.001) compared to hybrid techniques. These differences were no longer significant at 3 years. At 3 years, but not 2 years, VAS leg pain was lower for cMIS compared to hybrid techniques (adjusted p = 0.032). Those undergoing cMIS had fewer overall complications compared to hybrid techniques (adjusted p = 0.006), but a higher odds of pseudarthrosis (adjusted p = 0.039). Conclusions: In this review of a multicenter database for patients undergoing cMIS and hybrid surgery for ASD, hybrid procedures were associated with a greater CC improvement compared to cMIS techniques. cMIS was associated with superior ODI and back pain at 2 years, but this difference was no longer evident at 3 years. However, cMIS was associated with superior leg pain at 3 years. There were fewer complications following cMIS, with the exception of pseudarthrosis.
KW - adult spinal deformity
KW - minimally invasive
KW - scoliosis
KW - spinal fusion surgery
KW - spinopelvic alignment
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U2 - 10.3171/2021.7.SPINE21138
DO - 10.3171/2021.7.SPINE21138
M3 - Article
C2 - 34740175
AN - SCOPUS:85127521954
VL - 36
SP - 595
EP - 608
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
SN - 1547-5654
IS - 4
ER -