Lightning Podiums: Adult Spinal Deformity - Room 801A

Presented by: N. Anand


N. Anand(1), B. Khandehroo(1), S. Kahwaty(1), C. Kong(1), E. Nomoto(1)

(1) Cedars Sinai Medical Center, Spine Center, Los Angeles, CA, United States


Introduction: The impact of age on operative outcomes after CMIS correction for adult spinal deformity (ASD) has not been well studied. Often, more extreme correction is reserved in elderly patients to prevent the operative toll and further blood loss. Some have proposed that for the elderly population, favorable outcomes can be achieved despite less stringent correction in the sagittal plane. This study was conducted to analyze clinical and radiologic outcomes of elderly patients who underwent staged CMIS correction for ASD.

Methods: This is a retrospective study from a single center registry database of all patients who underwent staged CMIS correction for ASD (Cobb angle > 20 degrees or SVA > 50 mm or PI/LL mismatch > 10) from May 2011 to Oct 2016. All patients were treated with staged MIS strategies using MIS Lateral Lumbar Interbody Fusion (LLIF ± ALIF) followed by posterior percutaneous pedicle screw and rod instrumentation 3 days later. 76 patients underwent surgery at 3 or more levels. Only patients with an age > 65 years were included. 50 patients were identified and analyzed based on baseline and post op clinical and radiologic outcomes.

Results: In total, 50 patients were identified with a mean age of 71.9 (66-85, SD 5) and mean follow-up of 41 months (12-75). Mean blood loss after the first stage was 293ml (50-1500, SD 158) and the second stage was 480 ml (50-2500, 470), respectively (Table 1). Mean baseline HRQOL scores (VAS: 6.5 (1-10, SD 2.1), ODI: 45.7 (20-69, SD 13.2)) were significantly decreased at the final follow-up visit (VAS: 3.6 (0-8, SD 2.7), ODI: 36.7 (0-69, SD 19)) (p < .05). Baseline Cobb-angle, SVA, LL and PI/LL mismatch were significantly improved at the post-op follow-up (Table 2). The rate of pseudoarthrosis, PJK and major complications was 3.4%, 5%, and 13.5%, respectively (Table 3).

Conclusion: We found significant mean VAS and ODI score improvements at follow-up in elderly patients with minimal to moderate blood loss. This may suggest MIS correction is an effective alternative to open surgery in elderly patients owning to a reduced operative footprint.