Prospective Evaluation of Complex Adult Spinal Deformity (CAD) Treated With Minimally Invasive Surgery

Last updated: March 4, 2024
Sponsor: International Spine Study Group Foundation
Overall Status: Active - Recruiting

Phase

N/A

Condition

Birth Defects

Holoprosencephaly

Treatment

Index or spine revision surgery for complex adult spinal deformity

Clinical Study ID

NCT04885244
2138
  • Ages > 18
  • All Genders

Study Summary

Evaluate surgical treatment outcomes and identify best practice guidelines for complex adult spinal deformity (ASD) patients treated with minimally invasive approach, including radiographic and clinical outcomes, surgical and postoperative complications, risk factors for and revision surgery rates, and the role of standard work to improve patient outcomes and reduce surgical and postoperative complications.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. >18 years of age at the time of treatment 2. Diagnosis of adult congenital,degenerative, idiopathic, neuromuscular, inflammatory or iatrogenic spinal deformity 3. EOSfull body or standing 36" AP & Lateral images of entire spine 4. Surgery to be schedule totake place within 6 months (otherwise PROMs/Radiographic images to be recollected) 5.Surgery to include > 3 levels percutaneous posterior spinal instrumentation or 3 levelstand-alone lateral 6. And any one of the following: a. Radiographic criteria incorporating percutaneous posterior spinal instrumentation: i.PI-LL ≥ 25 degrees ii. Thoracolumbar/lumbar scoliosis ≥ 20 degrees iii. SVA >10cm iv. PT > 30 b. Procedural criteria: i. Single-position surgery ≥ 3 levels fused (Levels=vertebra; S1is counted as a level; S2 &/or pelvis/ilium is not) ii. Staged ≥ 3 levels fused withpercutaneous pedicle screws iii. 3 column osteotomy with percutaneous fixation iv. ACRincorporating open or percutaneous fixation

Exclusion

Exclusion Criteria:

  1. Deformity due to acute trauma
  2. Active spine tumor or infection
  3. Patient is unwilling or unable to complete questionnaires
  4. Women who are pregnant
  5. Prisoners -

Study Design

Total Participants: 500
Treatment Group(s): 1
Primary Treatment: Index or spine revision surgery for complex adult spinal deformity
Phase:
Study Start date:
July 28, 2021
Estimated Completion Date:
December 31, 2034

Study Description

Specific Aims:

  • Evaluate surgical treatment outcomes and identify best practice guidelines for complex adult spinal deformity (ASD) patients treated with minimally invasive approach, including radiographic and clinical outcomes, surgical and postoperative complications, risk factors for and revision surgery rates, and the role of standard work to improve patient outcomes and reduce surgical and postoperative complications.

    a. Complex ASD patients will be defined based upon clinical, radiographic and/or procedural criteria.

  • Develop and validate a standardized, universal complications classification system for minimally invasive spine surgery

  • Evaluate perioperative blood management approaches, transfusion requirements, including variance in thresholds for blood transfusion and associated complications for minimally invasive adult spinal deformity surgery

  • Evaluate clinical outcomes utilizing legacy patient reported outcome measures (PROMs) including Scoliosis Research Society 22r (SRS 22r) modified Oswestry Disability Index (mODI), Veterans RAND-12 (VR-12), and numeric pain rating scale (NRS), and patient reported outcome measurement information system (PROMIS).

  • Evaluate clinical outcomes stratifying by patient chronological and physiological age

  • Evaluate the cost for episode of care for minimally invasive CADS surgery and cost per QALY gain compared to open surgery for CADS

  • Evaluate the contribution of patient frailty to patient outcomes, cost of care, disability, and complications

  • Evaluate incidence of and risk factors for mental health (MH) compromise among ASD patients treated with MIS techniques, and establish best practice guidelines for assessing MH

  • Evaluate the association of MH with surgical complications, outcomes, hospital length of stay and cost for MIS ASD surgery

  • Evaluate the association of social health surgical complications, outcomes, hospital length of stay and cost for MIS ASD surgery and risk factors for routine (home) discharge vs. skilled nursing facility (SNF)/rehabilitation facility

  • Broaden the evaluation of the minimally invasive surgically treated ASD patient to maximize evaluation of the entirety of the episode of care to include steps that can be taken prior to surgery including "prehabilitation," pain management, and MH care to improve treatment outcomes, reduce cost, reduce hospital length of stay, reduce non-routing discharge and reduce early and late complications

  • Establish a core set of standard work guidelines to clinically and radiographically evaluate and treat ASD patients and evaluate the utility of standard work to improve outcomes for ASD and formulate best practice guidelines for minimally invasive surgical treatment of ASD

  • Evaluate the use of robotic techniques in minimally invasive spine surgery for ASD, and its impact on radiographic parameters and clinical outcomes

  • Evaluate the use of expandable cages in minimally invasive spine surgery for ASD, and its impact on radiographic parameters and clinical outcomes

  • Evaluate the OR efficiency, morbidity of surgery, and cost per episode of care relating to single-position vs. multi-position CADS surgery

  • Evaluate the prevalence and incidence of sacroiliac pain before/after complex adult spinal deformity surgery.

Connect with a study center

  • Barrow Neurological Institute

    Phoenix, Arizona 85013
    United States

    Active - Recruiting

  • Shiley Center for Orthopaedic Research and Education at Scripps Clinic

    La Jolla, California 92037
    United States

    Active - Recruiting

  • Cedars-Sinai Medical Center

    Los Angeles, California 90048
    United States

    Active - Recruiting

  • University of California - San Francisco Medical Center

    San Francisco, California 94143
    United States

    Active - Recruiting

  • University of Miami

    Miami, Florida 33125
    United States

    Active - Recruiting

  • Rush University, Department of Neurosurgery

    Chicago, Illinois 60612
    United States

    Active - Recruiting

  • Louisiana Spine Institute

    Shreveport, Louisiana 71101
    United States

    Active - Recruiting

  • University of Michigan, Department of Neurosurgery

    Ann Arbor, Michigan 48109
    United States

    Completed

  • Columbia University - New York-Presbyterian Och Spine Hospital

    New York, New York 10034
    United States

    Active - Recruiting

  • Weill Cornell Brain and Spine Center

    New York, New York 10065
    United States

    Site Not Available

  • Duke University Health System

    Durham, North Carolina 27710
    United States

    Active - Recruiting

  • University of Pittsburgh Medical Center

    Pittsburgh, Pennsylvania 15213
    United States

    Active - Recruiting

  • Semmes-Murphey

    Memphis, Tennessee 38120
    United States

    Active - Recruiting

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