PMID- 37327145 OWN - NLM STAT- MEDLINE DCOM- 20230904 LR - 20230905 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 39 IP - 3 DP - 2023 Sep 1 TI - Comparison of minimally invasive decompression alone versus minimally invasive short-segment fusion in the setting of adult degenerative lumbar scoliosis: a propensity score-matched analysis. PG - 394-403 LID - 10.3171/2023.4.SPINE221047 [doi] AB - OBJECTIVE: Patients with degenerative lumbar scoliosis (DLS) and neurogenic pain may be candidates for decompression alone or short-segment fusion. In this study, minimally invasive surgery (MIS) decompression (MIS-D) and MIS short-segment fusion (MIS-SF) in patients with DLS were compared in a propensity score-matched analysis. METHODS: The propensity score was calculated using 13 variables: sex, age, BMI, Charlson Comorbidity Index, smoking status, leg pain, back pain, grade 1 spondylolisthesis, lateral spondylolisthesis, multilevel spondylolisthesis, lumbar Cobb angle, pelvic incidence minus lumbar lordosis, and pelvic tilt in a logistic regression model. One-to-one matching was performed to compare perioperative morbidity and patient-reported outcome measures (PROMs). The minimal clinically important difference (MCID) for patients was calculated based on cutoffs of percentage change from baseline: 42.4% for Oswestry Disability Index (ODI), 25.0% for visual analog scale (VAS) low-back pain, and 55.6% for VAS leg pain. RESULTS: A total of 113 patients were included in the propensity score calculation, resulting in 31 matched pairs. Perioperative morbidity was significantly reduced for the MIS-D group, including shorter operative duration (91 vs 204 minutes, p < 0.0001), decreased blood loss (22 vs 116 mL, p = 0.0005), and reduced length of stay (2.6 vs 5.1 days, p = 0.0004). Discharge status (home vs rehabilitation), complications, and reoperation rates were similar. Preoperative PROMs were similar, but after 3 months, improvement was significantly higher for the MIS-SF group in the VAS back pain score (-3.4 vs -1.2, p = 0.044) and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) score (+10.3 vs +1.9, p = 0.009), and after 1 year the MIS-SF group continued to have significantly greater improvement in the VAS back pain score (-3.9 vs -1.2, p = 0.026), ODI score (-23.1 vs -7.4, p = 0.037), 12-Item Short-Form Health Survey MCS score (+6.5 vs -6.5, p = 0.0374), and VR-12 MCS score (+7.6 vs -5.1, p = 0.047). MCID did not differ significantly between the matched groups for VAS back pain, VAS leg pain, or ODI scores (p = 0.38, 0.055, and 0.072, respectively). CONCLUSIONS: Patients with DLS undergoing surgery had similar rates of significant improvement after both MIS-D and MIS-SF. For matched patients, tradeoffs were seen for reduced perioperative morbidity for MIS-D versus greater magnitudes of improvement in back pain, disability, and mental health for patients 1 year after MIS-SF. However, rates of MCID were similar, and the small sample size among the matched patients may be subject to patient outliers, limiting generalizability of these results. FAU - Echt, Murray AU - Echt M AD - 1Department of Surgery, Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. FAU - Bakare, Adewale A AU - Bakare AA AD - 2Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois. FAU - Varela, Jesus R AU - Varela JR AD - 2Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois. FAU - Platt, Andrew AU - Platt A AD - 3Department of Orthopaedics, The Daniel and Jane Och Spine Hospital, NewYork-Presbyterian, Columbia University Medical Center, New York, New York. FAU - Abdul Sami, Mohammed AU - Abdul Sami M AD - 2Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois. FAU - Molenda, Joseph AU - Molenda J AD - 4WellSpan Neurosurgery, York Hospital, York, Pennsylvania; and. FAU - Kerolus, Mena AU - Kerolus M AD - 5Department of Neurosurgery, Piedmont Healthcare, Atlanta Brain and Spine, Atlanta, Georgia. FAU - Fessler, Richard G AU - Fessler RG AD - 2Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois. LA - eng PT - Journal Article DEP - 20230609 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM MH - Humans MH - Adult MH - *Scoliosis/surgery MH - *Spondylolisthesis/surgery MH - Lumbar Vertebrae/surgery MH - Treatment Outcome MH - Propensity Score MH - *Spinal Fusion/methods MH - Back Pain/surgery MH - Minimally Invasive Surgical Procedures/methods MH - Decompression MH - Retrospective Studies OTO - NOTNLM OT - degenerative lumbar scoliosis OT - fusion OT - laminectomy OT - minimally invasive spine surgery OT - propensity score matching EDAT- 2023/06/16 19:16 MHDA- 2023/09/04 06:42 CRDT- 2023/06/16 13:13 PHST- 2022/09/19 00:00 [received] PHST- 2023/04/27 00:00 [accepted] PHST- 2023/09/04 06:42 [medline] PHST- 2023/06/16 19:16 [pubmed] PHST- 2023/06/16 13:13 [entrez] AID - 10.3171/2023.4.SPINE221047 [doi] PST - epublish SO - J Neurosurg Spine. 2023 Jun 9;39(3):394-403. doi: 10.3171/2023.4.SPINE221047. Print 2023 Sep 1.