A new retrospective study led by Neal Anand, M.D., an orthopedic spine surgeon with Cedars-Sinai Spine Center in Los Angeles, has examined outcomes for his new protocol for circumferential minimally invasive surgery (CMIS) in patients with adult spinal deformity (ASD). The results—Improved radiographic parameters and lower complication rates.
10-Year Data: Change Protocol, Lower Spine Fusion Complications
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The research team compared this new protocol to Dr. Anand’s original protocol. Dr. Anand told OTW, “This is the first paper of its kind describing longitudinal results over 10 years with long-term follow up of circumferential minimally invasive surgery for adult spinal deformity.”
The authors wrote, “The original protocol had 76 patients with an average age of 66.99 years and the new protocol had 53 patients with average age of 65.85 years. Preoperative and latest visual analog scale (VAS) scores in the original were 6.85 and 3.45 and in the new were 6.19 and 2.27. Delta-VAS scores were 3.27 and 4.27.”
“The Oswestry Disability Index (ODI) reduced from 45.84 to 32.91 in the original and from 44.21 to 25.39 in the new. Average delta-ODIs were 22.25 and 24.01. Preoperative, latest, and delta-SF physical component scores for the original were 35.38, 42.42, and 10.06 and for the new, 30.89, 39.49, and 11.93.”
“SF [short form] mental component scores were 50.96, 55.19, and 12.84 and 50.12, 52.99, and 8.85. The original and new protocols had latest Cobb angles of 11.54_ and 11.12_, delta-Cobb angles of 14.51 and 20.03, latest SVAs [sagittal vertical axis] of 42.85 and 30.58mm and latest PIeLL mismatch of 15.49 and 9.00mm.”
“In the original and the new, the average preoperative SVAs that reliably achieved a postoperative SVA of 50mm or less were 84 and 119mm, respectively, and the maximum delta-SVAs were 89 and 120mm. The new protocol had fewer surgical complications.”
Dr. Anand told OTW, “Changes in protocol and the establishment of a specific strategic staged protocol have shown a significant drop in the complication rate and a marked improvement in functional and radiological parameters. The most important of these is the dramatic reduction in cases of lumbar plexopathy by avoiding the transpsoas approach and instead performing a pre psoas oblique lateral approach to the spine.”
“Circumferential minimally invasive surgery is an acceptable alternative to the treatment of adult spinal deformity and this paper provides that evidence.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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