PMID- 38375684 OWN - NLM STAT- Publisher LR - 20240220 IS - 1528-1159 (Electronic) IS - 0362-2436 (Linking) DP - 2024 Feb 20 TI - Limited Improvement with Minimally Invasive Lumbar Decompression Alone for Degenerative Scoliosis with Cobb Angle over 20 Degrees: The Impact of Decompression Location. LID - 10.1097/BRS.0000000000004968 [doi] AB - STUDY DESIGN: Retrospective review of a prospectively collected multi-surgeon registry. OBJECTIVE: To evaluate the outcomes of minimally invasive (MI) decompression in patients with severe degenerative scoliosis (DS) and identify factors associated with poorer outcomes. SUMMARY OF BACKGROUND CONTEXT: MI decompression has gained widespread acceptance as a treatment option for patients with lumbar canal stenosis and DS. However, there is a lack of research regarding the clinical outcomes and the impact of MI decompression location in patients with severe DS exhibiting a Cobb angle exceeding 20 degrees. MATERIALS AND METHODS: Patients who underwent MI decompression alone were included and categorized into the DS or control groups based on Cobb angle (>20 degrees). Decompression location was labeled as "scoliosis-related" when the decompression levels were across or between end vertebrae, and "outside" when the operative levels did not include the end vertebrae. The outcomes including Oswestry Disability Index (ODI) were compared between the propensity score-matched groups for improvement and minimal clinical importance difference (MCID) achievement at >/=1 year postoperatively. Multivariable regression analysis was conducted to identify factors contributing to the non-achievement of MCID in ODI of the DS group at the >/=1 year timepoint. RESULTS: A total of 253 patients (41 DS) were included in the study. Following matching for age, gender, osteoporosis status, psoas muscle area, and preoperative ODI, the DS groups exhibited a significantly lower rate of MCID achievement in ODI (DS: 45.5% vs. control 69.0%, P=0.047). The "scoliosis-related" decompression (Odds ratio: 9.9, P=0.028) was an independent factor of non-achievement of MCID in ODI within the DS group. CONCLUSION: In patients with a Cobb angle>20 degrees, lumbar decompression surgery, even in the MI approach, may result in limited improvement of disability and physical function. Caution should be exercised when determining a surgical plan, especially when decompression involves the level between or across the end vertebrae. LEVEL OF EVIDENCE: 3. CI - Copyright (c) 2024 Wolters Kluwer Health, Inc. All rights reserved. FAU - Asada, Tomoyuki AU - Asada T AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. AD - University of Tsukuba, Institute of Medicine, Dept. of Orthopaedic Surgery, Tsukuba, Japan. FAU - Simon, Chad Z AU - Simon CZ AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Singh, Nishtha AU - Singh N AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Tuma, Olivia AU - Tuma O AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Subramanian, Tejas AU - Subramanian T AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. AD - Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA. FAU - Araghi, Kasra AU - Araghi K AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Lu, Amy Z AU - Lu AZ AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. AD - Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA. FAU - Mai, Eric AU - Mai E AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. AD - Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA. FAU - Kim, Yeo Eun AU - Kim YE AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. AD - Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA. FAU - Allen, Myles R J AU - Allen MRJ AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Korsun, Maximilian AU - Korsun M AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Zhang, Joshua AU - Zhang J AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Kwas, Cole AU - Kwas C AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Singh, Sumedha AU - Singh S AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Dowdell, James AU - Dowdell J AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Sheha, Evan D AU - Sheha ED AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Qureshi, Sheeraz A AU - Qureshi SA AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. FAU - Iyer, Sravisht AU - Iyer S AD - Hospital for Special Surgery, 535 E 70th St, New York, NY, USA. LA - eng PT - Journal Article DEP - 20240220 PL - United States TA - Spine (Phila Pa 1976) JT - Spine JID - 7610646 SB - IM COIS- Conflicts of Interest: Sheeraz Qureshi has the following disclosures: AMOpportunities: Other financial or material support; Annals of Translational Medicine: Editorial or governing board; Association of Bone and Joint Surgeons: Board or committee member; Cervical Spine Research Society: Board or committee member; Contemporary Spine Surgery: Editorial or governing board; Globus Medical: IP royalties; Paid consultant; Paid presenter or speaker; Hospital Special Surgery Journal: Editorial or governing board; HS2, LLC: Stock or stock Options; International Society for the Advancement of Spine Surgery (ISASS) - Program Committee member: Board or committee member; Lifelink.com: Other financial or material support; Lumbar Spine Research Society: Board or committee member; Minimally Invasive Spine Study Group: Board or committee member; North American Spine Society: Board or committee member; Simplify Medical, Inc.: Other financial or material support; Society of Minimally Invasive Spine Surgery (SMISS) - Program Committee member: Board or committee member; Spinal Simplicity: Other financial or material support; SpineGuard, Inc.: Paid consultant; Stryker: IP royalties; Paid consultant; Surgalign: Paid consultant; Tissue Differentiation Intelligence: Stock or stock Options; Viseon, Inc.: Paid consultant; Research support Sravisht Iyer has the following disclosures: Globus Medical: Paid presenter or speaker; Stryker: Paid presenter or speaker; Vertebral Columns/International Society for the Advancement of Spine Surgery (ISASS): Editorial or governing board EDAT- 2024/02/20 11:51 MHDA- 2024/02/20 11:51 CRDT- 2024/02/20 05:31 PHST- 2023/12/05 00:00 [received] PHST- 2024/01/24 00:00 [accepted] PHST- 2024/02/20 11:51 [medline] PHST- 2024/02/20 11:51 [pubmed] PHST- 2024/02/20 05:31 [entrez] AID - 00007632-990000000-00601 [pii] AID - 10.1097/BRS.0000000000004968 [doi] PST - aheadofprint SO - Spine (Phila Pa 1976). 2024 Feb 20. doi: 10.1097/BRS.0000000000004968.