A Modified Delphi Consensus Study to Quantify Surgical Burden of Degenerative Lumbar Spinal Procedures: The Minimally...

Area of Science:

• Spine Surgery
• Surgical Innovation
• Medical Classification Systems

Background:

• Minimally invasive degenerative lumbar spine procedures require a standardized method to quantify surgical invasiveness.
• Existing indices may not fully capture the spectrum of invasiveness in these complex procedures.

Purpose of the Study:

• To develop a practical and standardized classification system for quantifying surgical invasiveness in minimally invasive degenerative lumbar spine procedures.
• To establish a consensus-based framework for evaluating surgical approaches.

Main Methods:

• A modified Delphi process involving 45 international spine surgeons was employed.
• Iterative rounds of expert evaluation, literature review, and consensus surveys were conducted.
• The classification system was refined and validated using standardized case scenarios and expert review.

Main Results:

• A nine-factor classification system, MISS-INC (L), was developed, including operative time, approaches, blood loss, instrumentation, muscle dissection, anesthesia, levels, fusion, and revision status.
• Each factor is scored from 0 (least invasive) to 2 (most invasive), yielding a cumulative invasiveness score.
• Procedures were successfully stratified into minimally invasive, less invasive, and more invasive categories.

Conclusions:

• The MISS-INC (L) classification provides a consensus-based, user-friendly tool to quantify surgical invasiveness in minimally invasive lumbar spine surgery.
• This system can enhance communication, facilitate research, and improve patient counseling.
• Further validation of the MISS-INC (L) scale against clinical outcomes is recommended.