• Tomoyuki Asada, Chad Z Simon, Nishtha Singh, Olivia Tuma, Tejas Subramanian, Kasra Araghi, Amy Z Lu, Eric Mai, Yeo Eun Kim, Myles R J Allen, Maximilian Korsun, Joshua Zhang, Cole Kwas, Sumedha Singh, James Dowdell, Evan D Sheha, Sheeraz A Qureshi, and Sravisht Iyer.
• Hospital for Special Surgery, New York, NY.
• Spine. 2024 Aug 1; 49 (15): 103710451037-1045.

Study DesignRetrospective review of a prospectively collected multisurgeon registry.ObjectiveTo evaluate the outcomes of minimally invasive (MI) decompression in patients with severe degenerative scoliosis (DS) and identify factors associated with poorer outcomes.Summary Of Background ContextMI decompression has gained widespread acceptance as a treatment option for patients with lumbar canal stenosis and DS. However, there is a lack of research regarding the clinical outcomes and the impact of MI decompression location in patients with severe DS exhibiting a Cobb angle exceeding 20°.Materials And MethodsPatients who underwent MI decompression alone were included and categorized into the DS or control groups based on Cobb angle (>20°). Decompression location was labeled as "scoliosis-related" when the decompression levels were across or between end vertebrae and "outside" when the operative levels did not include the end vertebrae. The outcomes, including the Oswestry Disability Index (ODI), were compared between the propensity score-matched groups for improvement and minimal clinical importance difference (MCID) achievement at ≥1 year postoperatively. Multivariable regression analysis was conducted to identify factors contributing to the nonachievement of MCID in ODI of the DS group at the ≥1-year time point.ResultsA total of 253 patients (41 DS) were included in the study. Following matching for age, sex, osteoporosis status, psoas muscle area, and preoperative ODI, the DS groups exhibited a significantly lower rate of MCID achievement in ODI (DS: 45.5% vs. control 69.0%, P =0.047). The "scoliosis-related" decompression (odds ratio: 9.9, P =0.028) was an independent factor of nonachievement of MCID in ODI within the DS group.ConclusionsIn patients with a Cobb angle >20°, lumbar decompression surgery, even in the MI approach, may result in limited improvement of disability and physical function. Caution should be exercised when determining a surgical plan, especially when decompression involves the level between or across the end vertebrae.Level Of Evidence3.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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