35 - Comparison of Early and Late Complications after Circumferential Minim...

General Session: MIS-2

Presented by: J. Cuellar - View Audio/Video Presentation (Members Only)


J. Cuellar(1), N. Anand(1), K.-M. Fu(3), Z. Sardar(1), P. Park(2), M. Wang(3), V. Lafage(4), S. Nguyen(5), D. Okonkwo(6), J. Uribe(7), R. Eastlack(8), R. Fessler(9), V. Deviren(10), P. Mummaneni(10), C. Shaffrey(11), G. Mundis(5,8), International Spine Study Group

(1) Cedars Sinai, Los Angeles, CA, United States
(2) University of Michigan, Ann Arbor, MI, United States
(3) University of Miami, Miami, FL, United States
(4) NYU Langone Medical Center, New York, NY, United States
(5) San Diego Center for Spinal Disorders, San Diego, CA, United States
(6) University of Pittsburgh Medical Center, Pittsburgh, PA, United States
(7) University of South Florida, Tampa, FL, United States
(8) Scripps Clinic, La Jolla, CA, United States
(9) Rush University, Chicago, IL, United States
(10) University of California, San Francisco, San Francisco, CA, United States
(11) University of Virginia, Charlottesville, VA, United States


Hypothesis: CMIS results in lower early and late complication rates compared to HYB surgery for ASD. Design: This is a study of a retrospective, multicenter adult spinal deformity database.

Introduction: Variation in surgical approach for mild to moderate adult spinal deformity (ASD) exists. This study compares outcomes and complications (COMP) of circumferentially minimally invasive surgery (CMIS) and hybrid surgery (HYB; MIS lateral and open posterior) for treatment of ASD.

Methods: A study of a multicenter retrospective database of adult spinal deformity (Cobb>20°, SVA>5cm, PT>20, PI-LL>10, or Thoracic Kyphosis >60°) patients. Complications (as defined by Glassman et al) are reported as early (eCOMP) occurring within 30 days or late (lCOMP) after 30 days of surgery. Unpaired t-test and Mann Whitney U were used to assess differences between groups.

Results: 426 patients met inclusion criteria, 190 patients had a minimum of 2 year follow-up and were included for analysis, 104 CMIS and HYB 86. CMIS had significantly less (p< 0.001) EBL and OR compared to HYB (1584 v.481cc; 681 v 427 min). Radiographic and clinical parameters were similar between groups (table 1). A mean 4.7 levels were fused in CMIS and 8.2 in HYB (p< 0.001). CMIS had a significantly lower rate of early major (13.5% v 29.1%, p=0.007) and minor complications (9.6% v 36%, p< 0.001). Minor lCOMP occurred in 4.8% of CMIS and 9.3% in HYB (p=0.175). Major lCOMP occurred in 9.6% of CMIS and 15.1% of HYB (p=0.175). , Within the entire study population, the occurrence of an eCOMP (major or minor) resulted in significantly higher ODI at 2 years (table 1). Stratifying by approach, only CMIS major eCOMP had significantly higher ODI at 2 years (41.9 v 27.2, p=0.023) vs. no COMP.

Conclusions: Both approaches resulted in patients with satisfactory clinical and radiographic results. Although CMIS had significantly fewer COMP compared to HYB, the occurrence of a major eCOMP in CMIS left patients more disabled at 2 years than those without an eCOMP. Furthermore we found that patients with an eCOMP had worse ODI at 2 years.

Table 1