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Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo
Paul Park1, David O Okonkwo2, Stacie Nguyen3
1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Background:
Older age has been considered a relative contraindication to complex spinal procedures. Minimally invasive surgery (MIS) techniques to treat patients with adult spinal deformity (ASD) have emerged with the potential benefit of decreased approach-related morbidity.
Objective:
To determine whether a minimal clinically important difference (MCID) could be achieved in patients ages ≥ 65 years with ASD who underwent MIS.
Methods:
Multicenter database of patients who underwent MIS for ASD was queried. Outcome metrics assessed were Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for back and leg pain. On the basis of published reports, MCID was defined as a positive change of 12.8 ODI, 1.2 VAS back pain, and 1.6 VAS leg pain.
Results:
Forty-two patients were identified. Mean age was 70.3 years; 31 (73.8%) were women. Preoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis mismatch, and sagittal vertical axis were 35°, 24.6°, 14.2°, and 4.7 cm, respectively. Postoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis, and sagittal vertical axis were 18°, 25.4°, 11.9°, and 4.9 cm, respectively. A mean of 5.0 levels was treated posteriorly, and a mean of 4.0 interbody fusions was performed. Mean ODI improved from 47.1 to 25.1. Mean VAS back and leg pain scores improved from 6.8 and 5.9 to 2.7 and 2.7, respectively. Mean follow-up was 32.1 months. For ODI, 64.3% of patients achieved MCID. For VAS back and leg pain, 82.9% and 72.2%, respectively, reached MCID.
Conclusions:
MCID represents the threshold at which patients feel a meaningful clinical improvement has occurred. Our study results suggest that the majority of elderly patients with modest ASD can achieve MCID with MIS.
Insights
Minimally invasive surgery (MIS) allows elderly patients with adult spinal deformity (ASD) to achieve meaningful clinical improvement. A majority of patients experienced significant pain reduction and improved function after MIS procedures.
Area of Science:
- Spine surgery
- Orthopedics
- Geriatric medicine
Background:
- Older age was a contraindication for complex spinal procedures.
- Minimally invasive surgery (MIS) for adult spinal deformity (ASD) may reduce morbidity.
- This study investigates MIS outcomes in elderly ASD patients.
Purpose of the Study:
- To determine if elderly patients (≥ 65 years) with ASD can achieve a minimal clinically important difference (MCID) after MIS.
- To assess functional improvement and pain reduction in this demographic.
Main Methods:
- A multicenter database of patients undergoing MIS for ASD was queried.
- Outcomes included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain.
- MCID was defined based on established thresholds for ODI and VAS scores.
Main Results:
- 42 elderly patients (mean age 70.3 years) were analyzed.
- Significant improvements were observed in ODI (47.1 to 25.1) and VAS pain scores.
- 64.3% achieved MCID for ODI, 82.9% for back pain, and 72.2% for leg pain.
Conclusions:
- Minimally invasive surgery (MIS) enables elderly patients with adult spinal deformity (ASD) to reach a minimal clinically important difference (MCID).
- The majority of older adults with ASD can experience meaningful clinical improvement and functional recovery with MIS.
