PMID- 34560634 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240517 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 36 IP - 2 DP - 2022 Feb 1 TI - Patient outcomes after circumferential minimally invasive surgery compared with those of open correction for adult spinal deformity: initial analysis of prospectively collected data. PG - 203-214 LID - 10.3171/2021.3.SPINE201825 [doi] AB - OBJECTIVE: Circumferential minimally invasive spine surgery (cMIS) for adult scoliosis has become more advanced and powerful, but direct comparison with traditional open correction using prospectively collected data is limited. The authors performed a retrospective review of prospectively collected, multicenter adult spinal deformity data. The authors directly compared cMIS for adult scoliosis with open correction in propensity-matched cohorts using health-related quality-of-life (HRQOL) measures and surgical parameters. METHODS: Data from a prospective, multicenter adult spinal deformity database were retrospectively reviewed. Inclusion criteria were age > 18 years, minimum 1-year follow-up, and one of the following characteristics: pelvic tilt (PT) > 25 degrees , pelvic incidence minus lumbar lordosis (PI-LL) > 10 degrees , Cobb angle > 20 degrees , or sagittal vertical axis (SVA) > 5 cm. Patients were categorized as undergoing cMIS (percutaneous screws with minimally invasive anterior interbody fusion) or open correction (traditional open deformity correction). Propensity matching was used to create two equal groups and to control for age, BMI, preoperative PI-LL, pelvic incidence (PI), T1 pelvic angle (T1PA), SVA, PT, and number of posterior levels fused. RESULTS: A total of 154 patients (77 underwent open procedures and 77 underwent cMIS) were included after matching for age, BMI, PI-LL (mean 15 degrees vs 17 degrees , respectively), PI (54 degrees vs 54 degrees ), T1PA (21 degrees vs 22 degrees ), and mean number of levels fused (6.3 vs 6). Patients who underwent three-column osteotomy were excluded. Follow-up was 1 year for all patients. Postoperative Oswestry Disability Index (ODI) (p = 0.50), Scoliosis Research Society-total (p = 0.45), and EQ-5D (p = 0.33) scores were not different between cMIS and open patients. Maximum Cobb angles were similar for open and cMIS patients at baseline (25.9 degrees vs 26.3 degrees , p = 0.85) and at 1 year postoperation (15.0 degrees vs 17.5 degrees , p = 0.17). In total, 58.3% of open patients and 64.4% of cMIS patients (p = 0.31) reached the minimal clinically important difference (MCID) in ODI at 1 year. At 1 year, no differences were observed in terms of PI-LL (p = 0.71), SVA (p = 0.46), PT (p = 0.9), or Cobb angle (p = 0.20). Open patients had greater estimated blood loss compared with cMIS patients (1.36 L vs 0.524 L, p < 0.05) and fewer levels of interbody fusion (1.87 vs 3.46, p < 0.05), but shorter operative times (356 minutes vs 452 minutes, p = 0.003). Revision surgery rates between the two cohorts were similar (p = 0.97). CONCLUSIONS: When cMIS was compared with open adult scoliosis correction with propensity matching, HRQOL improvement, spinopelvic parameters, revision surgery rates, and proportions of patients who reached MCID were similar between cohorts. However, well-selected cMIS patients had less blood loss, comparable results, and longer operative times in comparison with open patients. FAU - Chou, Dean AU - Chou D AD - 1Department of Neurosurgery, University of California, San Francisco, San Francisco, California. FAU - Lafage, Virginie AU - Lafage V AD - 2Department of Orthopedic Surgery, New York University, New York, New York. FAU - Chan, Alvin Y AU - Chan AY AD - 3Department of Neurosurgery, University of California, Irvine, Orange, California. FAU - Passias, Peter AU - Passias P AD - 2Department of Orthopedic Surgery, New York University, New York, New York. FAU - Mundis, Gregory M AU - Mundis GM AD - 4Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California. FAU - Eastlack, Robert K AU - Eastlack RK AD - 5Department of Orthopedic Surgery, Scripps Health, La Jolla, California. FAU - Fu, Kai-Ming AU - Fu KM AD - 6Department of Neurosurgery, Weill Cornell Medical College, New York, New York. FAU - Fessler, Richard G AU - Fessler RG AD - 7Department of Neurosurgery, Rush University, Chicago, Illinois. FAU - Gupta, Munish C AU - Gupta MC AD - 8Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. FAU - Than, Khoi D AU - Than KD AD - 9Department of Neurosurgery, Duke University, Durham, North Carolina. FAU - Anand, Neel AU - Anand N AD - 10Department of Orthopedic Surgery, Cedars-Sinai, Los Angeles, California. FAU - Uribe, Juan S AU - Uribe JS AD - 11Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona. FAU - Kanter, Adam S AU - Kanter AS AD - 12Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Okonkwo, David O AU - Okonkwo DO AD - 12Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Bess, Shay AU - Bess S AD - 13Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - 14Department of Neurosurgery, Duke University, Durham, North Carolina. FAU - Kim, Han Jo AU - Kim HJ AD - 15Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York. FAU - Smith, Justin S AU - Smith JS AD - 16Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. FAU - Sciubba, Daniel M AU - Sciubba DM AD - 17Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and. FAU - Park, Paul AU - Park P AD - 18Department of Orthopedic Surgery, Washington University, St. Louis, Missouri. FAU - Mummaneni, Praveen V AU - Mummaneni PV AD - 1Department of Neurosurgery, University of California, San Francisco, San Francisco, California. CN - International Spine Study Group (ISSG) LA - eng PT - Journal Article DEP - 20210924 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM OTO - NOTNLM OT - adult spinal deformity OT - health-related quality of life OT - lumbar interbody fusion OT - minimal clinically important difference OT - scoliosis OT - spinopelvic parameters EDAT- 2021/09/25 06:00 MHDA- 2021/09/25 06:01 CRDT- 2021/09/24 20:33 PHST- 2020/10/26 00:00 [received] PHST- 2021/03/29 00:00 [accepted] PHST- 2021/09/25 06:01 [medline] PHST- 2021/09/25 06:00 [pubmed] PHST- 2021/09/24 20:33 [entrez] AID - 2021.3.SPINE201825 [pii] AID - 10.3171/2021.3.SPINE201825 [doi] PST - epublish SO - J Neurosurg Spine. 2021 Sep 24;36(2):203-214. doi: 10.3171/2021.3.SPINE201825. Print 2022 Feb 1.