Abstract
We developed a spinal deformity complexity checklist (SDCC) to assess the difficulty in performing a circumferential minimally invasive surgery (MIS) for adult spinal deformity (ASD).
A modified Delphi method of panel experts was utilized to construct an SDCC checklist of radiographic and patient-related characteristics that could affect the complexity of surgery via MIS approaches. Ten surgeons with expertise in MIS deformity surgery were queried to develop and refine the SDCC with 3 radiographic categories (X-ray, MRI, CT) and 1 patient-related category. Within each category, characteristics affecting MIS complexity were identified by initial round table discussion. Second-round discussion determined which characteristics substantially impacted complexity the most.
Thirteen characteristics within the X-ray category were determined. Spinopelvic characteristics, endpoints of instrumentation, and prior hardware/fusion were associated with increased complexity. Vertebral body rotation-as reflected by the Nash-Moe grade-added significant complexity. Psoas anatomy and spinal stenosis added the most complexity for the 5 MRI characteristics. Pre-existing fusion added the most complexity for the 3 CT characteristics, Osteoporosis and BMI affected complexity of the 5 patient-related characteristics.
The SDCC is a comprehensive list of pertinent radiographic and patient-related characteristics affecting complexity level for MIS deformity surgery. The value of the SDCC is that it allows rapid assessment of key factors when determining whether MIS surgery can be performed effectively and safely. Patients with scores of 4 in any characteristic should be considered challenging to treat with MIS; open surgery may be a better alternative.
