17 results on '"Pierce D"'
Search Results
2. Spinal Deformity Complexity Checklist for Minimally Invasive Surgery: Expert Consensus from the Minimally Invasive International Spine Study Group
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Anand, Neel, Mummaneni, Praveen V., Uribe, Juan S., Turner, Jay, Than, Khoi D., Chou, Dean, Nunley, Pierce D., Wang, Michael Y., Fessler, Richard G., Le, Vivian, Robinson, Jerry, Walker, Corey, Kahwaty, Sheila, Khanderhoo, Babak, Eastlack, Robert K., Okonkwo, David O., Kanter, Adam S., Fu, Kai-Ming G., Mundis, Gregory M., Jr., Passias, Peter, and Park, Paul
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- 2023
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3. Metal-Free Cortico-Pedicular Device for Supplemental Fixation in Lumbar Interbody Fusion
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Pierce D. Nunley, Robert K. Eastlack, Larry E. Miller, Kornelis A. Poelstra, J. Bridger Cox, Peter M. Shedden, and Marcus Stone
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Surgery ,Neurology (clinical) - Published
- 2023
4. Spinal Deformity Complexity Checklist for Minimally Invasive Surgery: Expert Consensus from the Minimally Invasive International Spine Study Group
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Neel Anand, Praveen V. Mummaneni, Juan S. Uribe, Jay Turner, Khoi D. Than, Dean Chou, Pierce D. Nunley, Michael Y. Wang, Richard G. Fessler, Vivian Le, Jerry Robinson, Corey Walker, Sheila Kahwaty, Babak Khanderhoo, Robert K. Eastlack, David O. Okonkwo, Adam S. Kanter, Kai-Ming G. Fu, Gregory M. Mundis, Peter Passias, and Paul Park
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Surgery ,Neurology (clinical) - Published
- 2023
5. Superion Interspinous Spacer Treatment of Moderate Spinal Stenosis: 4-Year Results
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Nunley, Pierce D., Patel, Vikas V., Orndorff, Douglas G., Lavelle, William F., Block, Jon E., and Geisler, Fred H.
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- 2017
- Full Text
- View/download PDF
6. Metal-free Cortico-pedicular Device for Supplemental Fixation in Lumbar Interbody Fusion
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Nunley, Pierce D., primary, Eastlack, Robert K., additional, Miller, Larry E., additional, Poelstra, Kornelis A., additional, Cox, J. Bridger, additional, Shedden, Peter M., additional, and Stone, Marcus, additional
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- 2023
- Full Text
- View/download PDF
7. Comparison of Complications and Clinical and Radiographic Outcomes Between Nonobese and Obese Patients with Adult Spinal Deformity Undergoing Minimally Invasive Surgery
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Park, Paul, Wang, Michael Y., Nguyen, Stacie, Mundis, Gregory M., Jr., La Marca, Frank, Uribe, Juan S., Anand, Neel, Okonkwo, David O., Kanter, Adam S., Fessler, Richard, Eastlack, Robert K., Chou, Dean, Deviren, Vedat, Nunley, Pierce D., Shaffrey, Christopher I., and Mummaneni, Praveen V.
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- 2016
- Full Text
- View/download PDF
8. Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery?
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Park, Paul, Okonkwo, David O., Nguyen, Stacie, Mundis, Gregory M., Jr., Than, Khoi D., Deviren, Vedat, La Marca, Frank, Fu, Kai-Ming, Wang, Michael Y., Uribe, Juan S., Anand, Neel, Fessler, Richard, Nunley, Pierce D., Chou, Dean, Kanter, Adam S., Shaffrey, Christopher I., Akbarnia, Behrooz A., Passias, Peter G., Eastlack, Robert K., and Mummaneni, Praveen V.
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- 2016
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9. Revision Surgery Rates After Minimally Invasive Adult Spinal Deformity Surgery: Correlation with Roussouly Spine Type at 2-Year Follow-Up?
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Robert K. Eastlack, David O. Okonkwo, Juan S. Uribe, Paul Park, Khoi D. Than, Dean Chou, Gregory M. Mundis, Kai-Ming G. Fu, Alvin Y. Chan, Neel Anand, Michael Wang, Adam S. Kanter, Pierce D. Nunley, Robert G. Fessler, and Praveen V. Mummaneni
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Male ,Reoperation ,Pelvic tilt ,medicine.medical_specialty ,Databases, Factual ,Radiography ,Kyphosis ,Pelvis ,Correlation ,Disability Evaluation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Orthopedic Procedures ,Aged ,Retrospective Studies ,Cobb angle ,business.industry ,Middle Aged ,medicine.disease ,Spine ,Sagittal plane ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Coronal plane ,Lordosis ,Spinal deformity ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Spinopelvic parameters have hitherto dictated much of adult spinal deformity (ASD) correction. The Roussouly classification is used for the normal adult spine. We evaluated whether a correlation would be found between the Roussouly type and the rate of revision surgery in patients with ASD undergoing circumferential minimally invasive spinal (cMIS) correction.A multicenter retrospective review of patients who had undergone cMIS surgery for ASD was performed. The inclusion criteria were age ≥18 years and 1 of the following: coronal Cobb angle20°, sagittal vertical axis5 cm, pelvic tilt20°, pelvic incidence (PI) to lumbar lordosis (LL) mismatch10°, cMIS surgery, and a minimum of 2 years of follow-up data available. The patients were classified by Roussouly type, and the clinical and radiographic outcomes were evaluated.A total of 104 patients were included in the present analysis. Of the 104 patients, 41 had Roussouly type 1, 32 had type 2, 23 had type 3, and 8 had type 4. Preoperatively, the patients with type 4 had the highest PI (P = 0.002) and LL (P0.001). Postoperatively, the PI-LL mismatch, Cobb angle, and sagittal vertical axis were not different among the 4 groups. However, the patients with type 2 had had the highest rate of complications (type 1, 29.3%; type 2, 61.3%; type 3, 34.8%; type 4, 25.0%; P = 0.031). The reoperation rates were comparable (type 1, 19.5%; type 2, 38.7%; type 3, 13.0%; type 4, 12.5%; P = 0.097). The reoperation rates for adjacent segment degeneration or proximal junctional kyphosis were also comparable (P = 0.204 and P = 0.060, respectively).We did not find a clear correlation between Roussouly type and the rate of revision surgery for adjacent segment disease or proximal junctional kyphosis in patients who had undergone cMIS surgery for ASD.
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- 2021
10. Minimally Invasive Spinal Deformity Surgery: Analysis of Patients Who Fail to Reach Minimal Clinically Important Difference
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Kai-Ming G. Fu, Adam S. Kanter, Pierce D. Nunley, Juan S. Uribe, Robert K. Eastlack, Paul Park, Praveen V. Mummaneni, G. Damian Brusko, David O. Okonkwo, Christopher I. Shaffrey, Stacie Tran, Gregory M. Mundis, Dean Chou, Michael Wang, and Neel Anand
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Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Adolescent ,Minimal Clinically Important Difference ,Scoliosis ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Deformity ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Patient Reported Outcome Measures ,Registries ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Minimal clinically important difference ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Sagittal plane ,Surgery ,Oswestry Disability Index ,Spinal Fusion ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Coronal plane ,Lordosis ,Quality of Life ,Etiology ,Female ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background It is well known that clinical improvements following surgical intervention are variable. While all surgeons strive to maximize reliability and degree of improvement, certain patients will fail to achieve meaningful gains. We aim to analyze patients who failed to reach minimal clinically important difference (MCID) in an effort to improve outcomes for minimally invasive deformity surgery. Methods Data were collected on a multicenter registry of minimally invasive surgery adult spinal deformity surgeries. Patient inclusion criteria were age ≥18 years, coronal Cobb ≥20 degrees, pelvic incidence-lumbar lordosis ≥10 degrees, or a sagittal vertical axis >5 cm. All patients had minimum 2 years' follow-up (N = 222). MCID was defined as 12.8 or more points of improvement in the Oswestry Disability Index. Up to 2 different etiologies for failure were allowed per patient. Results We identified 78 cases (35%) where the patient failed to achieve MCID at long-term follow-up. A total of 82 identifiable causes were seen in these patients with 14 patients having multiple causes. In 6 patients, the etiology was unclear. The causes were subclassified as neurologic, medical, structural, under treatment, degenerative progression, traumatic, idiopathic, and floor effects. In 71% of cases, an identifiable cause was related to the spine, whereas in 35% the cause was not related to the spine. Conclusions Definable causes of failed MIS ASD surgery are often identifiable and similar to open surgery. In some cases the cause is treatable and structural. However, it is also common to see failure due to pathologies unrelated to the index surgery.
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- 2020
11. Minimally Invasive Surgery for Mild-to-Moderate Adult Spinal Deformities: Impact on Intensive Care Unit and Hospital Stay
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Paul Park, Stacie Nguyen, Pierce D. Nunley, Richard G. Fessler, David O. Okonkwo, Gregory M. Mundis, Christopher I. Shaffrey, Kai-Ming G. Fu, Vedat Deviren, Robert K. Eastlack, Praveen V. Mummaneni, Dean Chou, Adam S. Kanter, Michael Wang, Juan S. Uribe, and Neel Anand
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Adult ,Male ,medicine.medical_specialty ,Visual analogue scale ,Scoliosis ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Statistical significance ,medicine ,Deformity ,Back pain ,Humans ,Minimally Invasive Surgical Procedures ,Prospective Studies ,Retrospective Studies ,business.industry ,Length of Stay ,Middle Aged ,medicine.disease ,Intensive care unit ,Surgery ,Intensive Care Units ,030220 oncology & carcinogenesis ,Propensity score matching ,Female ,Spinal Diseases ,Neurology (clinical) ,medicine.symptom ,Complication ,business ,030217 neurology & neurosurgery - Abstract
To compare circumferential minimally invasive (cMIS) versus open surgeries for mild-to-moderate adult spinal deformity (ASD) with regard to intensive care unit (ICU) and hospital lengths of stay (LOS).A retrospective review of 2 multicenter ASD databases with 426 ASD (sagittal vertical axis6 cm) surgery patients with 4 or more fusion levels and 2-year follow-up was conducted. ICU stay, LOS, and estimated blood loss (EBL) were compared between open and cMIS surgeries.Propensity matching resulted in 88 patients (44 cMIS, 44 open). cMIS were older (61 vs. 53 years, P = 0.005). Mean levels fused were 6.5 in cMIS and 7.1 in open (P = 0.368). Preoperative lordosis was higher in open than in cMIS (42.7° vs. 40.9°, P = 0.016), and preoperative visual analog score back pain was greater in open than in cMIS (7 vs. 6.2, P = 0.033). Preoperative and postoperative spinopelvic parameters and coronal Cobb angles were not different. EBL was 534 cc in cMIS and 1211 cc in open (P 0.001). Transfusions were less in cMIS (27.3% vs. 70.5%, P0.001). ICU stay was 0.6 days for cMIS and 1.2 days for open (P = 0.009). Hospital LOS was 7.9 days for cMIS versus 9.6 for open (P = 0.804).For patients with mild-to-moderate ASD, cMIS surgery had a significantly lower EBL and shorter ICU stay. Major and minor complication rates were lower in cMIS patients than open patients. Overall LOS was shorter in cMIS patients, but did not reach statistical significance.
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- 2019
12. Analysis of Complications with Staged Surgery for Less Invasive Treatment of Adult Spinal Deformity
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Paul Park, Kai-Ming G. Fu, Pierce D. Nunley, Richard G. Fessler, Neel Anand, Khoi D. Than, Peter G. Passias, David O. Okonkwo, Praveen V. Mummaneni, Juan S. Uribe, Robert K. Eastlack, Frank LaMarca, Adam S. Kanter, Gregory M. Mundis, and Stacie Tran
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Adult ,Male ,medicine.medical_specialty ,Less invasive ,Spinal Curvatures ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Medicine ,Humans ,Minimally Invasive Surgical Procedures ,In patient ,Aged ,Retrospective Studies ,business.industry ,Perioperative ,Middle Aged ,Surgery ,Oswestry Disability Index ,Spinal Fusion ,Treatment Outcome ,030220 oncology & carcinogenesis ,Staged surgery ,Propensity score matching ,Spinal deformity ,Female ,Neurology (clinical) ,business ,Complication ,030217 neurology & neurosurgery - Abstract
Background Spinal deformity surgery is often invasive and lengthy. Staging surgery over separate operative days may reduce complications. Staging is often used in minimally invasive treatment of adult spinal deformity (ASD). Objective To investigate the impact of staging on complication rates between hybrid (HYB; minimally invasive interbody with open posterior screw and rod fixation) and circumferential minimally invasive surgery (cMIS; minimally invasive interbody and screw/rod placement) procedures in patients with ASD. Methods A multicenter database of patients with ASD was reviewed. Patients who underwent staging (at least 3 levels) and 2 years of follow-up were analyzed. A total of 99 patients underwent staging: 53 cMIS and 46 HYB surgeries. Propensity matching for levels fused resulted in 19 patients in each group. Intra- and perioperative complications were assessed. Results Three HYB but no cMIS intraoperative complications occurred. More HYB patients had perioperative complications than cMIS patients. Neurologic complications were more frequent in HYB versus cMIS. Other complications did not differ significantly. Thirty-day reoperations were higher with cMIS than HYB, but there was no difference in reoperation rate at long-term follow-up. cMIS patients had greater improvement in the Oswestry Disability Index. There was no difference in complications between staged versus unstaged cMIS surgeries. Conclusions cMIS staged surgeries appear safer than HYB staged surgeries, and equally safe to cMIS unstaged surgeries. Perioperative complications were significantly higher for HYB staged surgeries. HYB surgeries may have better results when performed in a single setting, whereas cMIS surgeries can be performed in 1 or 2 stages depending on surgeon preference.
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- 2019
13. Home Versus Rehabilitation: Factors that Influence Disposition After Minimally Invasive Surgery in Adult Spinal Deformity Surgery
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Dean Chou, Amrit S. Khalsa, Adam S. Kanter, Pierce D. Nunley, Juan S. Uribe, Richard G. Fessler, Neel Anand, Frank La Marca, Paul Park, Robert K. Eastlack, Justin B. Ledesma, Stacie Tran, Gregory M. Mundis, and Praveen V. Mummaneni
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Pelvic tilt ,Adult ,Male ,Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Scoliosis ,Rehabilitation Centers ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Aged ,Retrospective Studies ,Postoperative Care ,030222 orthopedics ,Rehabilitation ,business.industry ,Retrospective cohort study ,Odds ratio ,Perioperative ,Middle Aged ,medicine.disease ,Home Care Services ,Surgery ,Treatment Outcome ,Female ,Neurology (clinical) ,Complication ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Minimally invasive surgery (MIS) correction for adult spinal deformity (ASD) may reduce the need the need for postoperative skilled nursing facility (SNF) or inpatient rehabilitation (IR) placement following surgery. The likelihood of requiring placement in a facility rather than home disposition may be influenced by various factors. In addition, the associations between discharge location and outcomes and complication rates have not been elucidated in these patients. In this study, we aimed to define factors predicting disposition to an SNF/IR and to elucidate the rates of complications occurring in patients sent to home versus to a facility.A retrospective review of a multicenter ASD database, which included patients who underwent surgery between 2009 and 2014. Inclusion criteria were age18 years, MIS as part of index surgery, location of discharge, and at least 1 of the following: pelvic tilt20°, sagittal vertical axis5 cm, pelvic incidence-lumbar lordosis mismatch10, or lumbar scoliosis20°. Patients with a 2-year follow-up were included. Preoperative demographic and radiographic data, postoperative (30 day) complications, and health-related quality of life were analyzed.A total of 182 patients met our inclusion criteria, including 113 who were discharged to home and 69 who were discharged to an SNF/IR. Older patients (50 years) were more likely to be discharged to an SNF/IR (P = 0.043). Those aged70 years were 6-fold more likely to go to an SNF/IR. No association was identified between discharge to an SNF/IR and any radiographic parameters except preoperative pelvic tilt (odds ratio [OR], 1.11; P = 0.009). Staged cases were more likely to be discharged to an SNF/IR (OR, 3.24; 95% confidence interval, 1.11-9.46; P = 0.032); otherwise, there was no difference in levels treated, operating time, estimated blood loss, osteotomy, or length of hospital stay. Patients requiring discharge to an SNF/IR had a higher rate of complications (58% vs. 39.8%; P = 0.017), including major complications (19.5% vs. 42%; P = 0.001), perioperative complications (14.2% vs. 31.9%; P = 0.004) and infections (3.5% vs. 13%; P = 0.016). Patients discharged to an SNF/IR had a higher rate of revision (19.5% vs. 33%; P = 0.035). Health-related quality of life measures were similar regardless of disposition.Older patients and those undergoing staged MIS deformity correction have a higher likelihood of postoperative disposition to an SNF/IR. Complications occurred more commonly in those patients requiring transfer to an SNF/IR after hospitalization.
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- 2018
14. Analysis of Complications with Staged Surgery for Less Invasive Treatment of Adult Spinal Deformity
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Than, Khoi D., primary, Park, Paul, additional, Tran, Stacie, additional, Mundis, Gregory M., additional, Fu, Kai-Ming, additional, Uribe, Juan S., additional, Okonkwo, David O., additional, Nunley, Pierce D., additional, Fessler, Richard G., additional, Eastlack, Robert K., additional, Kanter, Adam, additional, Anand, Neel, additional, LaMarca, Frank, additional, Passias, Peter G., additional, and Mummaneni, Praveen V., additional
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- 2019
- Full Text
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15. Superion Interspinous Spacer Treatment of Moderate Spinal Stenosis: 4-Year Results
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Jon E Block, William F. Lavelle, Douglas G Orndorff, Vikas V. Patel, Pierce D. Nunley, and Fred H. Geisler
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Adult ,Male ,medicine.medical_specialty ,Visual analogue scale ,Spinal stenosis ,Pain ,Neurogenic claudication ,Investigational device exemption ,Prosthesis Design ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Spinal Stenosis ,Risk Factors ,medicine ,Back pain ,Prevalence ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Aged ,Aged, 80 and over ,business.industry ,Lumbar spinal stenosis ,Prostheses and Implants ,Middle Aged ,medicine.disease ,Decompression, Surgical ,Surgery ,Oswestry Disability Index ,Causality ,Equipment Failure Analysis ,Survival Rate ,Treatment Outcome ,Editorial ,Female ,Neurology (clinical) ,medicine.symptom ,Claudication ,business ,030217 neurology & neurosurgery - Abstract
Objective To determine 4-year clinical outcomes in patients with moderate lumbar spinal stenosis treated with minimally invasive stand-alone interspinous process decompression using the Superion device. Methods The 4-year Superion data were extracted from a randomized, controlled Food and Drug Administration investigational device exemption trial. Patients with intermittent neurogenic claudication relieved with back flexion who failed at least 6 months of nonsurgical management were enrolled. Outcomes included Zurich Claudication Questionnaire (ZCQ) symptom severity (ss), physical function (pf) and patient satisfaction (ps) subdomains, leg and back pain visual analog scale (VAS), and Oswestry Disability Index (ODI). At 4-year follow-up, 89 of the 122 patients (73%) provided complete clinical outcome evaluations. Results At 4 years after index procedure, 75 of 89 patients with Superion (84.3%) demonstrated clinical success on at least 2 of 3 ZCQ domains. Individual component responder rates were 83% (74/89), 79% (70/89), and 87% (77/89) for ZCQss, ZCQpf, and ZCQps; 78% (67/86) and 66% (57/86) for leg and back pain VAS; and 62% (55/89) for ODI. Patients with Superion also demonstrated percentage improvements over baseline of 41%, 40%, 73%, 69%, and 61% for ZCQss, ZCQpf, leg pain VAS, back pain VAS, and ODI. Within-group effect sizes all were classified as very large (>1.0): 1.49, 1.65, 1.42, 1.12, and 1.46 for ZCQss, ZCQpf, leg pain VAS, back pain VAS, and ODI. Conclusions Minimally invasive implantation of the Superion device provides long-term, durable relief of symptoms of intermittent neurogenic claudication for patients with moderate lumbar spinal stenosis.
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- 2017
16. Comparison of Complications and Clinical and Radiographic Outcomes Between Nonobese and Obese Patients with Adult Spinal Deformity Undergoing Minimally Invasive Surgery
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Frank La Marca, Stacie Nguyen, Juan S. Uribe, Robert K. Eastlack, Michael Wang, Adam S. Kanter, Gregory M. Mundis, Pierce D. Nunley, Dean Chou, Neel Anand, Vedat Deviren, Paul Park, Praveen V. Mummaneni, David O. Okonkwo, Christopher I. Shaffrey, and Richard G. Fessler
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Databases, Factual ,Visual analogue scale ,medicine.medical_treatment ,Lumbar vertebrae ,Scoliosis ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Postoperative Complications ,medicine ,Back pain ,Humans ,Minimally Invasive Surgical Procedures ,030212 general & internal medicine ,Kyphosis ,Obesity ,Aged ,Retrospective Studies ,Lumbar Vertebrae ,business.industry ,Incidence ,Middle Aged ,medicine.disease ,Spine ,Oswestry Disability Index ,Surgery ,Musculoskeletal Abnormalities ,Radiography ,medicine.anatomical_structure ,Spinal Fusion ,Treatment Outcome ,Back Pain ,Spinal fusion ,Anesthesia ,Lordosis ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Body mass index ,030217 neurology & neurosurgery - Abstract
Obesity can be associated with increased complications and potentially worse outcomes. We aimed to evaluate the impact of obesity on complications and outcomes in patients with adult spinal deformity (ASD) who underwent minimally invasive surgery (MIS).A multicenter database of patients with ASD treated via MIS was queried. Of 190 patients in the database, 77 fit the inclusion criteria of 3 or more spinal levels treated minimally invasively. Patients were divided by body mass index (BMI)30 (nonobese; n = 59) and BMI ≥ 30 (obese; n = 18).Mean BMI was 24.6 nonobese and 35.0 obese (P0.001). There were mean 3.8 interbody fusions nonobese and 4.7 obese (P = 0.065). Levels treated posteriorly averaged 5.8 nonobese and 5.9 obese (P = 0.502). Mean follow-up was 34.4 months nonobese and 35.3 months obese (P = 0.976). Baseline radiographic parameters were similar between groups. Postoperatively, SVA averaged 83.9 mm obese and 20.4 mm nonobese (P = 0.002). Postoperative lumbar lordosis-pelvic incidence mismatch averaged 17.9° obese and 9.9° nonobese (P = 0.028). Both groups had improvement in Oswestry Disability Index (ODI) scores with no difference in postoperative ODI scores between groups (P = 0.090). Similarly, both groups had decreased VAS scores for back and leg pain with no difference between groups postoperatively. Twenty (33.9%) nonobese patients versus 7 (38.9%) obese patients had complications (P = 0.452).Our results suggest that obesity does not negatively impact complication rate or clinical outcomes in patients with ASD treated via MIS approaches.
- Published
- 2015
17. Can a Minimal Clinically Important Difference Be Achieved in Elderly Patients with Adult Spinal Deformity Who Undergo Minimally Invasive Spinal Surgery?
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Pierce D. Nunley, Juan S. Uribe, Michael Wang, Dean Chou, Khoi D. Than, Praveen V. Mummaneni, Stacie Nguyen, Christopher I. Shaffrey, Richard G. Fessler, Gregory M. Mundis, Vedat Deviren, Kai-Ming G. Fu, David O. Okonkwo, Frank La Marca, Behrooz A. Akbarnia, Neel Anand, Peter G. Passias, Robert K. Eastlack, Adam S. Kanter, and Paul Park
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Pelvic tilt ,Male ,medicine.medical_specialty ,Sacrum ,Databases, Factual ,Visual analogue scale ,medicine.medical_treatment ,Lumbar vertebrae ,Spinal Curvatures ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Back pain ,Humans ,Minimally Invasive Surgical Procedures ,030212 general & internal medicine ,Aged ,Lumbar Vertebrae ,business.industry ,Minimal clinically important difference ,Age Factors ,Recovery of Function ,humanities ,Surgery ,Oswestry Disability Index ,Radiography ,medicine.anatomical_structure ,Spinal Fusion ,Treatment Outcome ,Back Pain ,Spinal fusion ,Anesthesia ,Female ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
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.
- Published
- 2015
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