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World Neurosurg. 2016 Feb;86:168-72. doi: 10.1016/j.wneu.2015.09.072. Epub 2015 Sep 30.

Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery?

Author information

1
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. Electronic address: ppark@umich.edu.
2
Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
3
San Diego Center for Spinal Disorders, La Jolla, California.
4
Department of Neurosurgery, University of California, San Francisco, California.
5
Department of Orthopaedic Surgery, University of California, San Francisco, California.
6
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
7
Weill Cornell Brain and Spine Center, New York, New York.
8
Department of Neurological Surgery, University of Miami, Miami, Florida.
9
Department of Neurosurgery, University of South Florida, Tampa, Florida.
10
Cedars-Sinai Spine Center, Los Angeles, California.
11
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
12
Spine Institute of Louisiana, Shreveport, Louisiana.
13
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
14
Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, New York, New York.
15
Department of Orthopaedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California, USA.

Abstract

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°, 24.6°, 14.2°, and 4.7 cm, respectively. Postoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis, and sagittal vertical axis were 18°, 25.4°, 11.9°, 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.

KEYWORDS:

Adult spinal deformity; Elderly; Minimally invasive surgery; Spine

PMID:
26431736
DOI:
10.1016/j.wneu.2015.09.072
[Indexed for MEDLINE]

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