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2. Utility of the MISDEF2 Algorithm and Extent of Fusion in Open Adult Spinal Deformity Surgery With Minimum 2-Year Follow-up

Author

Bo Li, Gregory Hawryluk, Praveen V. Mummaneni, Michael Wang, Ratnesh Mehra, Minghao Wang, Darryl Lau, Rory Mayer, Kai-Ming Fu, and Dean Chou

Subjects
misdef2, complications, adult spinal deformity, Surgery, Original Article, Neurology (clinical), Neurology. Diseases of the nervous system, outcomes, RC346-429, minimally invasive surgery
Abstract

Objective: Long-segment fusion in adult spinal deformity (ASD) is often needed, but more focal surgeries may provide significant relief with less morbidity. The minimally invasive spinal deformity surgery (MISDEF2) algorithm guides minimally invasive ASD surgery, but it may be useful in open ASD surgery. We classified ASD patients undergoing focal decompression, limited decompression and fusion, and full correction according to MISDEF2 and correlated outcomes.Methods: A retrospective study of ASD patients treated by 2 surgeons at our hospital was performed. Inclusion criteria were: age > 50, minimum 2-year follow-up, and open ASD surgery. Tumor, trauma, and infections were excluded. Patients had open surgery including focal decompression, short segment fusion, or full scoliosis correction. All patients were categorized by MISDEF2 into 4 classes based upon spinopelvic parameters. Perioperative metrics were assessed. Radiographic correction, complications and reoperation were recorded.Results: A total of 136 patients met inclusion criteria. Mean follow-up was 46 ± 15.8 months (range, 24–118 months). Forty-seven underwent full deformity correction, 71 underwent short segment fusion, and 18 underwent decompression alone. There were 24 cases of class I, 66 cases of class II, 23 cases of class III, and 23 cases of class IV patients. Patients in class I and II had perioperative complication rates of 0% and 16.7% and revision rates of 8% and 21.2% when undergoing focal decompression or limited fusion. However, class II patients undergoing full correction had higher perioperative complications rate (p = 0.03) and revision surgery rates (p = 0.047). This difference was not seen in class III patients (p > 0.05). All class IV patients underwent full correction, but they had higher perioperative complication rates (p < 0.019), comparable revision surgery rates (p = 0.27), and better radiographic realignment (p < 0.001). In addition, full deformity correction was associated with longer length of stay, increased blood loss, and longer operative time (p < 0.001).Conclusion: The MISDEF2 algorithm may help guide ASD surgical decision making even in open surgery, with focal treatment used in class I and II patients as a viable alternative and full correction implemented in class IV patients because of severe malalignment. However, class II patients with ASD undergoing full deformity correction do have higher complication rates.

Published
2021

3. Indications

Author

Rory Mayer, Joshua Rivera, Dean Chou, and Edward C. Benzel

Published
2022

4. List of Contributors

Author

A. Karim Ahmed, Fadi Al-Saiegh, Todd J. Albert, Ilyas Aleem, Anthony M. Alvarado, Christopher P. Ames, Paul A. Anderson, Paul M. Arnold, Edward Benzel, Erica F. Bisson, Alessandro Boaro, Barrett S. Boody, Darrel S. Brodke, Nathaniel P. Brooks, Thomas J. Buell, Rebecca M. Burke, Jose A. Canseco, Joseph S. Cheng, Dean Chou, Jeff Ehresman, Sapan D. Gandhi, Zachary H. Goldstein, Michael W. Groff, Raghav Gupta, Tessa Harland, James S. Harrop, Robert F. Heary, Stanley Hoang, Kenneth J. Holton, Rajbir S. Hundal, Jacob R. Joseph, Iain H. Kalfas, Adam S. Kanter, Yoshihiro Katsuura, Han Jo Kim, Jun S. Kim, Kamal Kolluri, Daniel P. Leas, Ronald A. Lehman, Lawrence G. Lenke, Jason I. Liounakos, Rory Mayer, Praveen V. Mummaneni, Rani Nasser, Ahmad Nassr, Robert J. Owen, Fortunato G. Padua, Paul Park, Paul J. Park, Arati B. Patel, Rakesh Patel, Brenton Pennicooke, Zach Pennington, Frank M. Phillips, Julie G. Pilitsis, David W. Polly, Eric A. Potts, Raj D. Rao, Daniel K. Resnick, Joshua Rivera, Mohamed Saleh, Jose E. San Miguel, Rick C. Sasso, Shelly K. Schmoller, Daniel M. Sciubba, Christopher I. Shaffrey, Breanna L. Sheldon, Brandon A. Sherrod, Peter Shorten, Justin S. Smith, Kevin Swong, Lee A. Tan, Daniel J. Thomas, Huy Q. Truong, Alexander R. Vaccaro, Michael Y. Wang, Timothy J. Yee, Chun-Po Yen, and Ulas Yener

Published
2022

5. Neurosurgery Case Review: Questions and Answers

Author

Christian A. Bowers, Flavio Giordano, Faisal Abdulhamid Farrash, Pascal M. Jabbour, Alan Siu, Ramez Malak, Donald C. Shields, Unwar Ul-Haq, Jared J. Marks, Francisco Sanz, Achal Patel, Edward C. Benzel, Nabeel S. Alshafai, Hasel W. Slone, Jason S. Goldberg, Fahad Eid Alotaibi, Mohammad Almubaslat, Kamlesh B. Patel, Glenn C. Hunter, Anna Zicca, Michel Lacroix, Ibrahim Althubaiti, H. Francis Farhadi, Ahmed Mohyeldin, Robert L. Tiel, Homoud Aldahash, Claude-Edouard Châtillon, Franco DeMonte, Ossama Al-Mefty, Roberto Rafael Herrera, Nicholas J. Erickson, Nazer H. Qureshi, André Beer-Furlan, Judith Marcoux, Abdulrahman Yaqub Alturki, Ahmed Alaqeel, Badih Daou, Turki Elarjani, Sandeep Mittal, Kathleen E. Knudson, Alvin Chan, Amin B. Kassam, Kelsey A. Walsh, Mohammed Alghamd, Alfio Spina, Richard Bucholz, Fred Gentili, Marguerite Harding, Ricardo L. Carrau, Alwin Camacho, Pablo González-López, Faisal Al-Otaibi, Cristian Gragnaniello, Abdulrahman J. Sabbagh, Asem Salma, Stephen J. Hentschel, Joung H. Lee, Fahad AlKherayf, Rory Mayer, Rihaf Algain, John Woulfe, Stephen M. Russell, Han Zhuang Beh, Perry S. Bradford, Andrew Smith, Frederick Boop, Jorge E. Isaza, Vishal Patel, Eddie Perkins, Abdulrahman Albakr, Ibrahim Omeis, Christopher D. Baggott, Kevin Petrecca, Bassem Yousef Sheikh, Shaymaa Al-Umran, Michele Bailo, Jonathon Lebovitz, Pratap Chand, Edgar Gerardo Ordóñez-Rubiano, Aaron S. Gaekwad, Mohammed Almekhlafi, Jonathan Yun, Dimitri Sigounas, Julius July, Joseph A. Shehadi, Gustavo D. Luzardo, Ennio Antonio Chiocca, Shaan M. Raza, Alberto L. Gallotti, Anup Aggarwal, Ali Luqman, Mohammad A. Aziz-Sultan, Isabella Esposito, Eka Julianta Wahjoepramono, Imad N. Kanaan, Abdulrazag Ajlan, Hosam Al-Jehani, Brian Gill, Jaime Gasco, Brian Seaman, William T. Couldwell, José Luis Ledesma, Gary L. Gallia, Ananth K. Vellimana, Mark G. Hamilton, Da’Marcus Baymon, Almunder Algird, Evan S. Marlin, Ahmad I. Lary, Rudiger Von Ritschl, Afnan Uthman Alkhotani, Kevin Phan, Ayman Abdullah Albanyan, Essam A. Al Shail, Joshua Loewenstein, Mohammad Misfer Alshardan, Denis Klironomos, Ehtesham Ghani, Hector P. Rojas, Jeffery Atkinson, Matthew D. Smyth, Eldad J. Hadar, Erol Veznedaroglu, Mark A. Mahan, Qasim Al Hinai, Iván Verdú-Martínez, Peter J. Mews, Mohamed A. Labib, Randy L. Jensen, Rahul Shah, Amal Mokeem, Rolando Del Maestro, Denis Sirhan, Albert M. Isaacs, José Luis Montes, Mariam Alrashid, Jason Tullis, Hussam Abou-Al-Shaar, Justin Reagan, Daniel S. Ikeda, Pietro Mortini, David Sinclair, Hubert Lee, Mazda K. Turel, Michael S. Taccone, Alexander Y. Lin, Stephano Chang, Patrick Kim, Paul Steinbok, Luke G. F. Smith, Sami Obaid, Ashwag Al-Qurashi, Andrew Shaw, Abdul Haseeb Naeem, Exequiel P. Verdier, Ahmed Jaman Alzahrani, Lahbib A. Soualmi, Remi Nader, Ralph J. Mobbs, Soha Abdu M. Alomar, Mohammed Saeed Bafaqeeh, Zachary N. Litvack, Weston T. Northam, Joaquin Hidalgo, Robert F. Keating, Amgad S. Hanna, Jared Fridley, Bassam M. J. Addas, Monish Maharaj, Diana Ghinda, Daniel M. Prevedello, John S. Myseros, Lorenzo Genitori, Layla Batarfi, Khalid N. Almusrea, Samer K. Elbabaa, Adam Sauh Gee Wu, Anthony M. T. Chau, Naif M. Alotaibi, Saleh S. Baeesa, Kimberly Hamilton, Franz L. Ricklefs, Hashem Al Hashemi, Lissa Marie Peeling, Gareth Rutter, Sohum Desai, Philippe Mercier, Daniel Branch, Jorge E. Alvernia, Craig C. Weinkauf, Sunil Kukreja, Michel W. Bojanowski, Paul W. Gidley, Reem Bunyan, Domenic P. Esposito, Salah Baz, Randall C. Edgell, Christopher Evan Stewart, Burak Sade, Frank Gerold, Ali Alwadei, Nancy McLaughlin, Christopher J. Winfree, Terence Verla, Marc-Elie Nader, Andrew Jea, Filippo Gagliardi, Jean-Pierre Farmer, Giuliana Rizzo, Jeffrey P. Mullin, Ahmed T. Abdelmoity, Eric P. Roger, Anish Sen, Ivona Nemeiko, Mahmoud AlYamany, Anthony J. Caputy, Peter Nakaji, Nirmeen Zagzoog, Charles B. Agbi, Khalid Bajunaid, Matthew Pierson, Juan Ortega-Barnett, Justine Pearl, Maqsood Ahmad, Abdulmajeed Alahmari, and Robert A. Moumdjian

Subjects
Questions and answers, medicine.medical_specialty, Medical education, business.industry, medicine, Neurosurgery, business, Neuroscience, Case review
Published
2020

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