Minimally invasive surgery (MIS) can be used as an alternative or adjunct to traditional open techniques for the treatment of patients with adult spinal deformity. Recent advances in MIS techniques, including advanced anterior approaches, have increased the range of candidates for MIS deformity surgery. The minimally invasive spinal deformity surgery (MISDEF2) algorithm was created to provide an updated framework for decision-making when considering MIS techniques in correction of adult spinal deformity.
A modified algorithm was developed that incorporates a patient’s preoperative radiographic parameters and leads to one of 4 general plans ranging from basic to advanced MIS techniques to open deformity surgery with osteotomies. The authors surveyed 14 fellowship-trained spine surgeons experienced with spinal deformity surgery to validate the algorithm using a set of 24 cases to establish interobserver reliability. They then re-surveyed the same surgeons 2 months later with the same cases presented in a different sequence to establish intraobserver reliability. Responses were collected and analyzed. Correlation values were determined using SPSS software.
Over a 3-month period, 14 fellowship-trained deformity surgeons completed the surveys. Responses for MISDEF2 algorithm case review demonstrated an interobserver kappa of 0.85 for the first round of surveys and an interobserver kappa of 0.82 for the second round of surveys, consistent with substantial agreement. In at least 7 cases, there was perfect agreement between the reviewing surgeons. The mean intraobserver kappa for the 2 surveys was 0.8.
The MISDEF2 algorithm was found to have substantial inter- and intraobserver agreement. The MISDEF2 algorithm incorporates recent advances in MIS surgery. The use of the MISDEF2 algorithm provides reliable guidance for surgeons who are considering either an MIS or an open approach for the treatment of patients with adult spinal deformity.
Correspondence Kai-Ming Fu: Cornell Medical Center, New York, NY. firstname.lastname@example.org.INCLUDE WHEN CITING Published online October 25, 2019; DOI: 10.3171/2019.7.SPINE181104.Disclosures All authors: grant for this study from ISSG. Praveen Mummaneni: consultant for DePuy Spine, Stryker, and Globus; direct stock ownership in Spinicity/ISD; clinical or research support from NREF; royalties from DePuy Spine, Thieme Publishers, and Springer Publishing; honoraria from Spineart; and grant from AOSpine. Paul Park: consultant for Globus, NuVasive, Zimmer Biomet, Medtronic, and Allosource; and royalties from Globus. Christopher Shaffrey: consultant for and patent holder with Medtronic, NuVasive, and Zimmer Biomet. Michael Wang: consultant for DePuy Synthes, K2M, Spineology, and Stryker; direct stock ownership in Spinicity/ISD and Medical Device Partners; and medical advisory board of Vallum. Juan Uribe: consultant for NuVasive, Si Bone, and Misonix; and direct stock ownership in and royalties from NuVasive. Richard Fessler: consultant for and royalties from DePuy Synthes, teaching and education for Benvenue, and ownership in InQ Innovations. Dean Chou: consultant for Globus and Medtronic, and royalties from Globus. Adam Kanter: consultant for and royalties from NuVasive and Zimmer Biomet. David Okonkwo: consultant for Stryker and royalties from NuVasive and Zimmer Biomet. Greg Mundis: consultant for NuVasive, K2M, Viseon, Seaspine, and Allosource; direct stock ownership in NuVasive and Viseon; royalties from K2M; and board member of Global Spine Outreach and San Diego Spine Foundation. Robert Eastlack: consultant for NuVasive, Aesculap, K2M, SI Bone, Stryker, Seaspine, Baxter, Titan, and Carevature; direct stock ownership in NuVasive, Seaspine, Alphatec Spine, Invuity, and Spine Innovation; ownership in Spine Innovation; royalties from Globus, NuVasive, and Aesulap; patent holder with Invuity, Spine Innovation, and NuTech; research support from NuVasive, Alphatec Spine, and Seaspine; and board member/committee appointments to Nocimed, Matrisys, San Diego Spine Foundation, and Society of Lateral Access Surgery and Scoliosis Research Society. Pierce Nunley: consultant for Spineology, K2M, Centinel Spine, Zimmer Spine, Vertiflex, Camber, and Integrity; direct stock ownership in Amedica, Paradigm, Spineology, and Camber; patent holder with Camber; and patent holder with and royalties from K2M, Zimmer Spine, and Safewire. Neel Anand: consultant for Medtronic, Globus, GYS Tech, TheraCell, and Spinal Balance; direct stock ownership in Medtronic, Globus, GYS Tech, TheraCell, Atlas Spine, AF Cell, Bonovo, Paradigm Spine, and Spinal Balance; royalties from Medtronic, Globus, and Elsevier; scientific advisory board for Globus, GYS Tech, TheraCell, and Spinal Balance; speaker for DePuy Synthes and Stryker; and editor of Gray’s Anatomy. Lawrence Lenke: consultant for Medtronic, K2M, and DePuy Synthes; royalties from Medtronic; reimbursement for airfare/hotel from AOSpine, Broadwater, Seattle Science Foundation, Scoliosis Research Society, Stryker Spine, and The Spinal Research Foundation; royalties from Medtronic and Quality Medical Publishing; philanthropic research funding from Evans Family Donation and Fox Family Foundation; grant support to institution from DePuy Synthes, Scoliosis Research Society, EOS, and Setting Scoliosis Straight Foundation; fellowship support to institution from AOSpine; and expert witness in a patent infringement case for Fox Rothschild, LLC. Khoi Than: consultant for Bioventus and past consultant for Medtronic. Kai- Ming Fu: consultant for SI-BONE, Johnson and Johnson, and Globus.
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