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Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers.

Publication ,  Journal Article
Wang, MY; Tran, S; Brusko, GD; Eastlack, R; Park, P; Nunley, PD; Kanter, AS; Uribe, JS; Anand, N; Okonkwo, DO; Than, KD; Shaffrey, CI ...
Published in: J Neurosurg Spine
August 23, 2019

OBJECTIVE: The past decade has seen major advances in techniques for treating more complex spinal disorders using minimally invasive surgery (MIS). While appealing from the standpoint of patient perioperative outcomes, a major impediment to adoption has been the significant learning curve in utilizing MIS techniques. METHODS: Data were retrospectively analyzed from a multicenter series of adult spinal deformity surgeries treated at eight tertiary spine care centers in the period from 2008 to 2015. All patients had undergone a less invasive or hybrid approach for a deformity correction satisfying the following inclusion criteria at baseline: coronal Cobb angle ≥ 20°, sagittal vertical axis (SVA) > 5 cm, or pelvic tilt > 20°. Analyzed data included baseline demographic details, severity of deformity, surgical metrics, clinical outcomes (numeric rating scale [NRS] score and Oswestry Disability Index [ODI]), radiographic outcomes, and complications. A minimum follow-up of 2 years was required for study inclusion. RESULTS: Across the 8-year study period, among 222 patients, there was a trend toward treating increasingly morbid patients, with the mean age increasing from 50.7 to 62.4 years (p = 0.013) and the BMI increasing from 25.5 to 31.4 kg/m2 (p = 0.12). There was no statistical difference in the severity of coronal and sagittal deformity treated over the study period. With regard to radiographic changes following surgery, there was an increasing emphasis on sagittal correction and, conversely, less coronal correction. There was no statistically significant difference in clinical outcomes over the 8-year period, and meaningful improvements were seen in all years (ODI range of improvement: 15.0-26.9). Neither were there statistically significant differences in major complications; however, minor complications were seen less often as the surgeons gained experience (p = 0.064). Operative time was decreased on average by 47% over the 8-year period.Trends in surgical practice were seen as well. Total fusion construct length was unchanged until the last year when there was a marked decrease in conjunction with a decrease in interbody levels treated (p = 0.004) while obtaining a higher degree of sagittal correction, suggesting more selective but powerful interbody reduction methods as reflected by an increase in the lateral and anterior column resection techniques being utilized. CONCLUSIONS: The use of minimally invasive methods for adult spinal deformity surgery has evolved over the past decade. Experienced surgeons are treating older and more morbid patients with similar outcomes. A reliance on selective, more powerful interbody approaches is increasing as well.

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Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

August 23, 2019

Start / End Page

1 / 8

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences
 

Citation

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Wang, M. Y., Tran, S., Brusko, G. D., Eastlack, R., Park, P., Nunley, P. D., … MIS-ISSG Group, . (2019). Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers. J Neurosurg Spine, 1–8. https://doi.org/10.3171/2019.6.SPINE19531
Wang, Michael Y., Stacie Tran, G Damian Brusko, Robert Eastlack, Paul Park, Pierce D. Nunley, Adam S. Kanter, et al. “Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers.J Neurosurg Spine, August 23, 2019, 1–8. https://doi.org/10.3171/2019.6.SPINE19531.
Wang MY, Tran S, Brusko GD, Eastlack R, Park P, Nunley PD, et al. Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers. J Neurosurg Spine. 2019 Aug 23;1–8.
Wang, Michael Y., et al. “Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers.J Neurosurg Spine, Aug. 2019, pp. 1–8. Pubmed, doi:10.3171/2019.6.SPINE19531.
Wang MY, Tran S, Brusko GD, Eastlack R, Park P, Nunley PD, Kanter AS, Uribe JS, Anand N, Okonkwo DO, Than KD, Shaffrey CI, Lafage V, Mundis GM, Mummaneni PV, MIS-ISSG Group. Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers. J Neurosurg Spine. 2019 Aug 23;1–8.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

August 23, 2019

Start / End Page

1 / 8

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences