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Related Experiment Video

Updated: Jan 5, 2026

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The MISDEF2 algorithm: an updated algorithm for patient selection in minimally invasive deformity surgery.

Praveen V Mummaneni1, Paul Park2, Christopher I Shaffrey3

  • 11Department of Neurological Surgery, University of California, San Francisco, California.

Journal of Neurosurgery. Spine
|October 27, 2019
PubMed
Summary
This summary is machine-generated.

The MISDEF2 algorithm offers reliable guidance for adult spinal deformity surgery, showing substantial agreement among surgeons for minimally invasive techniques. This framework aids decision-making for both MIS and open surgical approaches.

Keywords:
ACR = anterior column realignmentASD = adult spinal deformityLL-PI = lumbar lordosis–pelvic incidenceLLIF = lateral lumbar interbody fusionMIS = minimally invasive surgeryMISDEFMISDEF = MIS deformityMISDEF2MISDEF2 = MISDEF revision 2PT = pelvic tiltSVA = sagittal vertical axisTLIF = transforaminal lumbar interbody fusionadult spinal deformityminimally invasivespine surgery

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Area of Science:

  • Spine surgery
  • Orthopedic surgery
  • Surgical innovation

Background:

  • Minimally invasive surgery (MIS) is an alternative to open surgery for adult spinal deformity.
  • Advances in MIS techniques expand candidacy for these procedures.
  • A decision-making framework is needed for MIS in adult spinal deformity.

Purpose of the Study:

  • To introduce the minimally invasive spinal deformity surgery (MISDEF2) algorithm.
  • To provide an updated framework for selecting MIS techniques in adult spinal deformity correction.
  • To assess the reliability of the MISDEF2 algorithm.

Main Methods:

  • A modified algorithm was developed incorporating preoperative radiographic parameters.
  • Four fellowship-trained spine surgeons evaluated 24 cases using the algorithm.
  • Interobserver and intraobserver reliability were assessed via two survey rounds.

Main Results:

  • The MISDEF2 algorithm demonstrated substantial interobserver agreement (kappa=0.85 and 0.82).
  • Intraobserver agreement was also substantial (mean kappa=0.8).
  • Perfect agreement was observed in at least 7 cases.

Conclusions:

  • The MISDEF2 algorithm shows significant inter- and intraobserver agreement.
  • The algorithm integrates recent advancements in MIS surgery.
  • It offers reliable guidance for choosing between MIS and open approaches for adult spinal deformity.