PMID- 26431736
OWN - NLM
STAT- MEDLINE
DCOM- 20160617
LR  - 20220408
IS  - 1878-8769 (Electronic)
IS  - 1878-8750 (Linking)
VI  - 86
DP  - 2016 Feb
TI  - Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients 
      with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery?
PG  - 168-72
LID - S1878-8750(15)01239-5 [pii]
LID - 10.1016/j.wneu.2015.09.072 [doi]
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 degrees , 24.6 degrees , 14.2 degrees , and 4.7 cm, respectively. 
      Postoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar 
      lordosis, and sagittal vertical axis were 18 degrees , 25.4 degrees , 11.9 degrees , 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.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Park, Paul
AU  - Park P
AD  - Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. 
      Electronic address: ppark@umich.edu.
FAU - Okonkwo, David O
AU  - Okonkwo DO
AD  - Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
FAU - Nguyen, Stacie
AU  - Nguyen S
AD  - San Diego Center for Spinal Disorders, La Jolla, California.
FAU - Mundis, Gregory M Jr
AU  - Mundis GM Jr
AD  - San Diego Center for Spinal Disorders, La Jolla, California.
FAU - Than, Khoi D
AU  - Than KD
AD  - Department of Neurosurgery, University of California, San Francisco, California.
FAU - Deviren, Vedat
AU  - Deviren V
AD  - Department of Orthopaedic Surgery, University of California, San Francisco, 
      California.
FAU - La Marca, Frank
AU  - La Marca F
AD  - Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
FAU - Fu, Kai-Ming
AU  - Fu KM
AD  - Weill Cornell Brain and Spine Center, New York, New York.
FAU - Wang, Michael Y
AU  - Wang MY
AD  - Department of Neurological Surgery, University of Miami, Miami, Florida.
FAU - Uribe, Juan S
AU  - Uribe JS
AD  - Department of Neurosurgery, University of South Florida, Tampa, Florida.
FAU - Anand, Neel
AU  - Anand N
AD  - Cedars-Sinai Spine Center, Los Angeles, California.
FAU - Fessler, Richard
AU  - Fessler R
AD  - Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
FAU - Nunley, Pierce D
AU  - Nunley PD
AD  - Spine Institute of Louisiana, Shreveport, Louisiana.
FAU - Chou, Dean
AU  - Chou D
AD  - Department of Neurosurgery, University of California, San Francisco, California.
FAU - Kanter, Adam S
AU  - Kanter AS
AD  - Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
FAU - Shaffrey, Christopher I
AU  - Shaffrey CI
AD  - Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
FAU - Akbarnia, Behrooz A
AU  - Akbarnia BA
AD  - San Diego Center for Spinal Disorders, La Jolla, California.
FAU - Passias, Peter G
AU  - Passias PG
AD  - Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint 
      Diseases, New York, New York.
FAU - Eastlack, Robert K
AU  - Eastlack RK
AD  - Department of Orthopaedic Surgery, Scripps Clinic Torrey Pines, La Jolla, 
      California, USA.
FAU - Mummaneni, Praveen V
AU  - Mummaneni PV
AD  - Department of Neurosurgery, University of California, San Francisco, California.
CN  - International Spine Study Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20150930
PL  - United States
TA  - World Neurosurg
JT  - World neurosurgery
JID - 101528275
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Back Pain/diagnosis/etiology/prevention & control
MH  - Cohort Studies
MH  - Databases, Factual
MH  - Female
MH  - Humans
MH  - *Lumbar Vertebrae
MH  - Male
MH  - *Minimally Invasive Surgical Procedures
MH  - Radiography
MH  - Recovery of Function
MH  - *Sacrum
MH  - Spinal Curvatures/complications/diagnostic imaging/*surgery
MH  - *Spinal Fusion
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Adult spinal deformity
OT  - Elderly
OT  - Minimally invasive surgery
OT  - Spine
EDAT- 2015/10/04 06:00
MHDA- 2016/06/18 06:00
CRDT- 2015/10/04 06:00
PHST- 2015/07/24 00:00 [received]
PHST- 2015/09/15 00:00 [revised]
PHST- 2015/09/16 00:00 [accepted]
PHST- 2015/10/04 06:00 [entrez]
PHST- 2015/10/04 06:00 [pubmed]
PHST- 2016/06/18 06:00 [medline]
AID - S1878-8750(15)01239-5 [pii]
AID - 10.1016/j.wneu.2015.09.072 [doi]
PST - ppublish
SO  - World Neurosurg. 2016 Feb;86:168-72. doi: 10.1016/j.wneu.2015.09.072. Epub 2015 
      Sep 30.