Assessing the Incremental Benefits of Minimally Invasive Surgery for Frail Adult Spinal Deformity Patients — The International Society for the Study of the Lumbar Spine
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Assessing the Incremental Benefits of Minimally Invasive Surgery for Frail Adult Spinal Deformity Patients (#1125)

Peter G Passias 1 , Peter S Tretiakov 1 , Rachel L Joujon-Roche 1 , Bailey T Imbo 1 , Tyler K Williamson 1 , Oscar Krol 1 , Shaleen Vira 2 , Bassel Diebo 3 , Stephane Owusu-sarpong 1 , Jordan Lebovic 1 , Renaud Lafage 4 , Virginie Lafage 5 , Dean Chou 6 , Praveen Mummaneni 6 , Paul Park 7 , Saman Shabani 6 , M. Burhan Janjua 8 , Justin S Smith 9 , Andrew J Schoenfeld 10
  1. Department of Orthopaedic Surgery, NYU Langone, New York, NY, United States
  2. UT Southwestern, Dallas
  3. SUNY Downstate, New York
  4. Hospital for Special Surgery, New York
  5. Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
  6. Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
  7. Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan, USA
  8. Department of Neurotrauma, Neuro-oncology, and Spine , Mercy Health , Chicago, IL, USA
  9. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
  10. Department of Orthopedic Surgery, Brigham and Women's Center for Surgery and Public Health, Boston, MA, USA

 

INTRODUCTION: Minimally-invasive surgery (MIS) is an emerging and increasingly utilized technique within spine surgery that may facilitate recovery and increase fusion rates. Yet, there remains a paucity in literature as to the potential increased incremental benefit MIS spine surgery may offer frail patients. This study sought to assess if frail and severely frail patients undergoing minimally invasive spine surgery will display increased incremental patient-reported, perioperative, and post-operative benefits as compared to not-frail patients. 

METHODS: 820 Operative MIS patients undergoing surgery with pre-(BL) and 1-year(1Y) postop radiographic/HRQL data were included. Patients were stratified into 3 groups: Not Frail (NF), Frail (F), and Severely Frail (SF). Means comparison analyses via one-way Analysis of Variance (ANOVA) assessed baseline demographics, HRQLs, and radiographics. Analysis of post-operative outcomes was conducted via ANCOVA and MANCOVA while controlling for BL PI-LL and S1SS.

RESULTS: 120 MIS patients (69.12±10.60 years, 61.7% female, 29.05±6.23 kg/m2, mean CCI: 2.13±1.54) were included. At BL, NF patients had significantly lower mean BMI than F or SF patients (p=<.001, .001), and both NF and F patients had significantly lower mean CCI than SF (p=.001, .002). Baseline radiographic analysis revealed significant differences in BL Roussouly typing (p=.044), relative spinopelvic (SP) alignment (p=.028), and BL SP categorization (p=.016), with NF patients presenting with significantly higher Roussouly typing, lower relative SP alignment, and lower SP categorization than SF patients (p=.046, .021, .027). By BL HQRLs, signficantly signficant differences were observed between frailty categories in ODI, SRS-22 and all subcomponents, EQ5D and all subcomponents, and SF-36 and all subcomponents (all p<.05). Perioperatively, NF patients experienced significantly shorter LOS than F patients (p=.047). Post-operatively, signficant differences were noted between BL and 1Y  in SRS-22 Activity scores (p=.044), with SF patients demonstrating the greatest positive difference in scores. Adjusting for BL PI-LL and S1SS, by 1Y there were also signficant differences noted between groups in ODI amd SF-36 and all subcomponents (all p<.05). In terms of radiographic alignment at 1Y, significant differences were observed in acheiving ideal sacral slope (=.018), ideal lumbar lordosis (p=.018), idea global tilt (p=.018), and spinopelvic categorization (p=.037), with F and SF patients presenting with the lowest SP categorizations. Assessing post-operative complications, signficant differences were observed in undergoing any medical complication or infection (p=.005, .041), with SF patients demonstrating the lowest rates overall.

DISCUSSION: Despite more severe HRQL and radiographic descriptors at baseline, as well as increased overall surgical invasiveness and EBL, patients with increased frailty states operated on using MIS techniques demonstrated increased incremental benefits post-operative patient-reported and radiographic outcomes at 1Y as compared to their NF counterparts. This may suggest that MIS spine surgery can offer substantial benefits to the frail patient by increasing their chance of achieving radiographic alignment and quality-of-life targets.

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