• Michael Y Wang, Juan Uribe, Praveen V Mummaneni, Stacie Tran, G Damian Brusko, Paul Park, Pierce Nunley, Adam Kanter, David Okonkwo, Neel Anand, Dean Chou, Christopher I Shaffrey, Kai-Ming Fu, Gregory M Mundis, Robert Eastlack, and Minimally Invasive Surgery-International Spine Study Group.
• Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address: MWang2@med.miami.edu.
• World Neurosurg. 2020 May 1; 137: e499-e505.

BackgroundIt 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.MethodsData 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.ResultsWe 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.ConclusionsDefinable 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.Copyright © 2020. Published by Elsevier Inc.

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