PMID- 30797202 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240521 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 30 IP - 6 DP - 2019 Feb 22 TI - Is achieving optimal spinopelvic parameters necessary to obtain substantial clinical benefit? An analysis of patients who underwent circumferential minimally invasive surgery or hybrid surgery with open posterior instrumentation. PG - 833-838 LID - 10.3171/2018.11.SPINE181261 [doi] AB - OBJECTIVE: It is now well accepted that spinopelvic parameters are correlated with clinical outcomes in adult spinal deformity (ASD). The purpose of this study was to determine whether obtaining optimal spinopelvic alignment was absolutely necessary to achieve a minimum clinically important difference (MCID) or substantial clinical benefit (SCB). METHODS: A multicenter retrospective review of patients who underwent less-invasive surgery for ASD was conducted. Inclusion criteria were age >/= 18 years and one of the following: coronal Cobb angle > 20 degrees , sagittal vertical axis (SVA) > 5 cm, pelvic tilt (PT) > 20 degrees , or pelvic incidence to lumbar lordosis (PI-LL) mismatch > 10 degrees . A total of 223 patients who were treated with circumferential minimally invasive surgery or hybrid surgery and had a minimum 2-year follow-up were identified. Based on optimal spinopelvic parameters (PI-LL mismatch +/- 10 degrees and SVA < 5 cm), patients were divided into aligned (AL) or malaligned (MAL) groups. The primary clinical outcome studied was the Oswestry Disability Index (ODI) score. RESULTS: There were 74 patients in the AL group and 149 patients in the MAL group. Age and body mass index were similar between groups. Although the baseline SVA was similar, PI-LL mismatch (9.9 degrees vs 17.7 degrees , p = 0.002) and PT (19 degrees vs 24.7 degrees , p = 0.001) significantly differed between AL and MAL groups, respectively. As expected postoperatively, the AL and MAL groups differed significantly in PI-LL mismatch (-0.9 degrees vs 13.1 degrees , p < 0.001), PT (14 degrees vs 25.5 degrees , p = 0.001), and SVA (11.8 mm vs 48.3 mm, p < 0.001), respectively. Notably, there was no difference in the proportion of AL or MAL patients in whom an MCID (52.75% vs 61.1%, p > 0.05) or SCB (40.5% vs 46.3%, p > 0.05) was achieved for ODI score, respectively. Similarly, no differences in percentage of patients obtaining an MCID or SCB for visual analog scale back and leg pain score were observed. On multivariate analysis controlling for surgical and preoperative demographic differences, achieving optimal spinopelvic parameters was not associated with achieving an MCID (OR 0.645, 95% CI 0.31-1.33) or an SCB (OR 0.644, 95% CI 0.31-1.35) for ODI score. CONCLUSIONS: Achieving optimal spinopelvic parameters was not a predictor for achieving an MCID or SCB. Since spinopelvic parameters are correlated with clinical outcomes, the authors' findings suggest that the presently accepted optimal spinopelvic parameters may require modification. Other factors, such as improvement in neurological symptoms and/or segmental instability, also likely impacted the clinical outcomes. FAU - Park, Paul AU - Park P AD - 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. FAU - Fu, Kai-Ming AU - Fu KM AD - 2Department of Neurosurgery, Cornell Medical Center, New York, New York. FAU - Eastlack, Robert K AU - Eastlack RK AD - 3Department of Orthopaedic Surgery, Scripps Clinic, La Jolla. FAU - Tran, Stacie AU - Tran S AD - 4San Diego Center for Spinal Disorders, San Diego, California. FAU - Mundis, Gregory M AU - Mundis GM AD - 3Department of Orthopaedic Surgery, Scripps Clinic, La Jolla. FAU - Uribe, Juan S AU - Uribe JS AD - 5Barrow Neurologic Institute, Phoenix, Arizona. FAU - Wang, Michael Y AU - Wang MY AD - 6Department of Neurosurgery, University of Miami, Florida. FAU - Than, Khoi D AU - Than KD AD - 7Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon. FAU - Okonkwo, David O AU - Okonkwo DO AD - 8Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. FAU - Kanter, Adam S AU - Kanter AS AD - 8Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. FAU - Nunley, Pierce D AU - Nunley PD AD - 9Spine Institute of Louisiana, Shreveport, Louisiana. FAU - Anand, Neel AU - Anand N AD - 10Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California. FAU - Fessler, Richard G AU - Fessler RG AD - 11Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; and. FAU - Chou, Dean AU - Chou D AD - 12Department of Neurosurgery, University of California, San Francisco, California. FAU - Oppenlander, Mark E AU - Oppenlander ME AD - 1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. FAU - Mummaneni, Praveen V AU - Mummaneni PV AD - 12Department of Neurosurgery, University of California, San Francisco, California. CN - International Spine Study Group LA - eng PT - Journal Article DEP - 20190222 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM OTO - NOTNLM OT - adult spinal deformity OT - minimally invasive surgery OT - outcomes OT - posterior approach OT - spinopelvic alignment OT - spinopelvic parameters OT - surgical technique EDAT- 2019/02/24 06:00 MHDA- 2019/02/24 06:01 CRDT- 2019/02/24 06:00 PHST- 2018/10/21 00:00 [received] PHST- 2018/11/28 00:00 [accepted] PHST- 2019/02/24 06:01 [medline] PHST- 2019/02/24 06:00 [pubmed] PHST- 2019/02/24 06:00 [entrez] AID - 2018.11.SPINE181261 [pii] AID - 10.3171/2018.11.SPINE181261 [doi] PST - epublish SO - J Neurosurg Spine. 2019 Feb 22;30(6):833-838. doi: 10.3171/2018.11.SPINE181261.