Outcomes of Circumferential Minimally-Invasive Technique vs Open Technique in Adult Spinal Deformity Surgery Patients Over 80 Years of Age

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

PT

Peter S. Tretiakov, BS

United States

Presenting Author (Person doing the Podium Present(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

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Co-Author(s)

JU

Juan S. Uribe, M.D.

Chief of Spinal Disorders
Barrow Neurological Institute
phoenix, Arizona, United States
NA

Nima Alan

Resident Neurosurgeon
University of Pittsburgh Medical Center, United States
VL

Vivian P. Le, M.P.H.

Columbia University Irving Medical Center, United States
PD

Pooja R. Dave

Miami, Florida, United States
JM

Jamshaid M. Mir, MD

Research Fellow
NYU Langone Health | NY Spine Institute, United States
RL

Renaud Lafage, MS

Senior Biomedical engineer
Lenox Hill Hospital
new york, New York, United States
BL

Breton Line, BS

Research Assistant
Denver International Spine Center
Denver, Colorado, United States
MW

Michael Y. Wang, MD

Professor
University of Miami Department of Neurosurgery
Miami, Florida, United States
DO

David O. Okonkwo, M.D., Ph.D.

University of Pittsburgh Medical Center, United States
NA

Neel Anand, MD

Medical Director: Spine Center
Cedars Sinai Medical Center
Los Angeles, California, United States
RF

Richard G. Fessler, M.D., Ph.D.

Professor
Rush University Medical Center
Chicago, Illinois, United States
KF

Kai-Ming Fu, M.D., Ph.D.

Weil Cornell Medical Center, United States
Pierce D. Nunley, MD

Director
Spine Insitute of Louisiana
Shreveport, Louisiana, United States
PP

Paul Park, MD

United States
jT

jay Turner

United States
AK

Adam S. Kanter, M.D.

Hoag Pickup Family Neurosciences Institute, United States
Gregory M. Mundis, Jr., M.D.

Director San Diego Spine Fellowship
Scripps Clinic
Encinitas, California, United States
DC

Dean Chou, MD

Columbia University, United States
CA

Christopher Ames

United States
RH

Robert A. Hart, MD

Surgeon
Swedish Neuroscience Institute
Seattle, WA, United States
JS

Justin Smith, MD, PhD

University of Virginia
Charlottesville, Virginia, United States
CS

Christopher I. Shaffrey, Sr., MD

Duke University Medical Center
Durham, North Carolina, United States
FS

Frank Schwab, MD

Lenox Hill Hospital, Northwell Health
New York, New York, United States
SB

Shay Bess, M.D.

Spine surgeon
Denver International Spine Center
castle rock, Colorado, United States
Robert K. Eastlack, M.D.

Partner, Spine Section, Division of Orthopaedic Surgery
Scripps Clinic
La Jolla, California, United States
PM

Praveen V. Mummaneni, MD, MBA

Professor
University of California San Francisco
san francisco, California, United States
DB

Douglas Burton, MD

Department Chair, Orthopedic Surgery and Sports Medicine
University of Kansas Medical Center
Kansas City, Kansas, United States
II

International Spine Study Group Foundation ISSGF

na
ISSGF
Brighton, Colorado, United States

Submitter(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

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Disclosure(s):

Peter G. Passias, M.D.: No relevant disclosure to display

Robert K. Eastlack, M.D.: No relevant disclosure to display

Introduction: Circumferential minimally-invasive surgery (cMIS) techniques in ASD surgery may provide benefit in reducing physiologic burden, but the utility of such surgeries in patients greater than 80 years of age has not been assessed.

Purpose: Assess 2-year outcomes for cMIS versus open surgery in ASD patients ≥80 years of age.

Methods: Operative ASD patients ≥18yrs with complete pre-(BL) and 2-year(2Y) postop radiographic/HRQL data were assessed. Patients aged 80 years and older were then isolated for analysis and compared by surgical technique: Open vs cMIS. BL and peri/post-operative factors were assessed using ANOVA and Bonferroni-adjusted ANCOVA while controlling for BL CCI and posterior levels fused. Propensity score matching (PSM) was used to align cMIS vs Open groups by BL CCI, C7-S1 SVA, PI-LL, and C7PL.

Results: 174 patients were included after PSM, split evenly between cMIS and Open (62.85±13.93 years, 75.7% female, 29.23±6.64 kg/m2). 19.5% (n=34) were octogenarians; 29.4% operated via cMIS vs 70.6% Open. At baseline, patients were comparable in gender, BMI, and prior history of spine surgery (all p>.05). When assessing baseline frailty, Passias et al. and Miller et al. frailty scores were not significantly different (both p>.05), and Chi-square analysis revealed equal distribution of frailty in cMIS vs Open patients (χ2(2)=.446, p=.788). Peri-operatively, cMIS patients had lower operative times, (274.5 vs 398.0 min, p=.006) and EBL (200.0 vs 1765.4 mL p= <.001), were less likely to undergo osteotomy (p=.002) or decompression (p=.024), and had less mean posterior levels fused (5.00 vs 11.83, p=.001). cMIS patients were also less likely to require SICU care (10% vs 75%, p<.001), and had lower mean hospital length of stay (4.6 vs 10.1 days, p=.013). Post-operatively, Open patients reported significantly higher SRS-22 Appearance and Mental domain scores (both p<.005), and were more likely to reach MCID in both domains by 2Y (p=.025, .024, respectively). Improvement by ODI and EQ5D/EQ5D-VAS were comparable by 2Y. Radiographically, by 2Y no significant differences were observed between groups in terms of meeting GAP or age-adjusted targets (all p>.05), though Open patients did report higher mean change in PI-LL (p=.047). In terms of post-operative complications, while no differences were noted in peri- or post-operative major or minor complications (all p>.05), cMIS patients were significantly more likely to require reoperation for radiographic sagittal imbalance by 2Y when controlling for CCI and levels fused (20.0% vs 8.3%, p<.001). By 2Y, there were no recorded deaths in the cMIS nor Open octogenarians.

Conclusion: Octogenarians present a unique challenge to spine surgeons due to the potential for decreased physiologic reserve, and heightened risk for complications. Our comparison of adult spinal deformity patients undergoing circumferential minimally-invasive versus open surgery demonstrates that while cMIS patients benefit from decreased blood loss, operative time, and SICU and hospital length of stay, both Open and cMIS patients benefit from similar improvement in patient-reported outcomes. Likewise, Open technique, though more invasive, may also reduce the risk for reoperation due to radiographic instability by 2Y post-operatively.