Study reference

Study characteristics

Patient characteristics

Intervention (I)

Comparison / control (C)

Follow-up

Outcome measures and effect size

Bach, 2014

SR and meta-analysis of: 11 retrospective case series, 1 prospective case series and one retrospective cohort

Literature search up to [month/year]

A: Anand et al., 2008

B: Benglis et al., 2008

C: Anand et al., 2010

D: Dakwar et al., 2010

E: Tormenti et al., 2010

F: Wang and Munameni, 2010

G: Isaacs et al., 2010

H: Marchi et al., 2012

I: Wang, 2012

J: Deukmedjan et al., 2012

K: Deukmedjan et al., 2013

L: Anand et al., 2013

M: Caputo et al., 2012

Source of funding:

One of the authors (JSU) is a paid consultant and receives research

grants from NuVasive, LLC (San Diego, CA, USA).

Inclusion criteria SR: diagnosis of adult degenerative scoliosis and some level of disability one study also included a small number of patients with idiopathic scoliosis and iatrogenic scoliosis, studies with short-term follow-up to capture early complications were also included

Exclusion criteria SR: anatomical descriptions, case reports, commentaries, literature reviews, studies addressing congenital and idiopathic scoliosis

13 studies included

Describe intervention: minimal invasive surgery techniques addressing adult degenerative scoliosis.

A: minimal invasive surgery, circumferential fusion, direct lateral transpsoas approach for discectomy and fusion with polyetheretherketone cage and rh-BMP2. All fusions to the sacrum included L5-S1 fusion with the Trans1 Axial Lumbar Interbody Fusion technique. Posteriorly, multilevel percutaneous screws were inserted using the CD Horizon Longitude system

D: minimally invasive, lateral retroperitoneal transpsoas approach placind interbody grafts

E: minimally invasive transpsoas extreme lateral interbody fusion (XLIF) and open posterior segmental pedicle screw instrumentation with transforaminal lumbar interbody fusion (TLIF) for the correction of coronal deformity

F: combined approach of minimally invasive transpsoas extreme lateral interbody fusion (XLIF) and open posterior segmental pedicle screw instrumentation with transforaminal lumbar interbody fusion (TLIF) for the correction of coronal deformity (retrospective) F: minimally invasive surgery for adult thoracolumbar deformity surgery: lateral interbody fusion followed by posterior percutaneous screw fixation and possible minimally invasive surgical transforaminal lumbar interbody fusion if fusion near the lumbosacral junction was necessary

H: minimally invasive lateral approach using hyperlordotic cages in the treatment of mild sagittal imbalance

J: minimally invasive lateral retroperitoneal transpsoas interbody fusion (MIS LIF) for release of the anterior longitudinal ligament

K: Lateral minimally invasive thoracolumbar instrumentation

L: MIS correction of spinal deformity with fusion of 2 or more levels including: degenerative scoliosis (54), idiopathic scoliosis (11), and iatrogenic scoliosis (6). All underwent a combination of 3 MIS techniques: direct lateral interbody fusion (66), axial lumbar interbody fusion (34), and posterior instrumentation (67)

Describe control:

No control group

End-point of follow-up:

A: 2.5 months

B: 10 months

C: 22 months

D: 11 months

E: 10.5 months

F: 13.4 months

G: 1.5 months

H: 6 months

J: 9 months

K: 17.4 months

L: 39 months

M: 14.3 months

For how many participants were no complete outcome data available?

(intervention/control)

Not described in the review

Outcome measure-1 pain (delta VAS)

A: pre 7,1, post 4,8=2,3= 32% reduction

C: pre 7,1, post 3,03= 4,07 = 57% reduction

D: pre 8,1, post, 24= 5,7, 70% reduction

E: XLIF pre 8.8, post 3,5=5,3

Posterior-only group pre 9,5, post 4=5,5 58% reduction

F: 27.8 leg, 39.6 back

H: pre 88, post 51 (after 1 week)= 37 reduction 42%

J: 26% reduction

K: 28.7

L: 17.3

Mean treatment intensity scale improvement was 18.9

Outcome measure-2 function (delta ODI)

C: pre 39,13, post 7=32.1 3 82% reduction

D: 23.7

H: pre 82, post (6 weeks) 44, reduction 54%

 33

J: 18% reduction

K: 20

L: 9.3

Outcome measure-2 surgical and medical complications (pooled)

Neurologic: 14%

Motor: 4%

Sensory: 10.5%

Infectious: 6%

Construct: 8.9%

Pulmonary: 3%

Cardiac 3.5%

Other 8.5%

Drazin,

2011

SR and meta-analysis of cohort studies, not much details are specified

Literature search from 1950 up to 2011

A: Benz et al., 2001

B: Bess et al., 2009

C: Best & Sasso, 2007

D: Casselini et al., 2007

E: Daubs et al., 2007

F: DeWald&Stanley, 2006

G: Galiano et al., 2005

H: Jo et al., 2010

I: Kilincer et al., 2005

J: Li et al., 2009

K: Raffo & Lauerman, 2006

L: Ragab et al., 2003

M: Rosen et al., 2007

N: Scheufler et al., 2010

O: Shabat et al., 2008

P: Di Silvestre et al., 2010

Q: Smith et al., 2011

R: Wang et al., 2003

Setting and Country:

Source of funding:

[commercial / non-commercial / industrial co-authorship]

Inclusion criteria SR: English language and keywords were adult scoliosis surgery and adult spine deformity surgery reporting postoperative outcomes

Exclusion criteria SR: patient age younger than 60

22 studies included

Describe intervention:

“surgery”

Spinal deformity surgery

B: operative (based on operator and patient preference) or nonoperative treatment

C: lumbar decompression

E: thoracic or lumbar arthrodesis procedure consisting of 5 levels or greater

G: laminectomy in octogenerians

H: lumbar interbody fusion

J: operative treatment

M: minimally invasive lumbar spinal surgery

N: less invasive image-guided correction (3-8 segments) by multisegmental transforaminal lumbar interbody fusion and facet fusions

O: surgery for lumbar spinal stenosis in octogenarians

P: dynamic stabilization (Dynesys system) without fusion combined with decompressive laminectomy, in cases with associated stenosis

Q: scoliosis surgery

Describe control:

No control group

End-point of follow-up:

B: NA

C: 4,6 years

E: 4,2 years

G: 2,7 years

H: 2 years

J: 2,8 years

M: 0,8 years

N: 1,6 years

O: 3,1 years

P: 4,5 years

Q: 2 years

For how many participants were no complete outcome data available?

(intervention/control)

unclear

Outcome measure-Oswestry Disablity Index

B: pre: 49 post: NA

E: pre: 49, post: 25, reduction 49%

G: pre NA, post 36

J: pre 45, post 18, reduction 60%

M: pre 48, post 27, reduction 44%

N: pre 57, post 25, reduction 56%

P: pre 52, post 27, reduction 48%

Q: pre 43, post 24, reduction 44%

Outcome measure-2: Visual analog scale (VAS)

B: pre 7.8, post NA

C: pre 8,8. Post 1,8, reduction 80%

G: pre 8.5, post 3,9, reduction 61%

H: pre 7.1, post 2,8, reduction 61%

M: pre 5.7, post 2.2, reduction 61%

N: pre 7.5, post 2.6, reduction 65%

O: pre 8.8, post 3.6, reduction 59%

P: pre 6.7, post 3.3, reduction 51%

Outcome measure-3: patient reported outcomes

Percentages of excellent/good, fair/unchanged and poor/worse are reported

Outcome measure-4: complications (all complications were grouped

and the total rate of complications calculated)

Dural tear 5,5%

Wound infection 5,3%

Pulmonary 5%

Renal 4,7%

Neurological 4,7%

Gastrointestinal 4,5%

Cardiac 3,7%

Liang, 2012

SR and meta-analysis of 1 RCT and 15 nonrandomized studies

Literature search up to [1950-31 December 2010]

A: Marchesi, 1991

B: Grubb, 1994

C: Iizuka and Yamada, 2006

D: Cho et al., 2007

E: Pateder et al., 2007

F: Berven et al., 2007

G: Wu et al., 2008

H: Glassman et al., 2009

I: Kluba et al., 2009

J: Crandall and Revella, 2009

K: Khan et al., 2009

L: Di Silvestre et al., 2010

M: Transfeldt et al., 2010

N: Ploumis et al., 2010 (RCT)

O: Keorochana et al., 2010

P: Li et al., 2011

Source of funding:

unknown

Inclusion criteria SR: (i) clinical studies; (ii) RCTs; (iii) quasi RCTs; (iv) prospective studies; (v) retrospective studies; (vi) case series; and (vii) studies involving patients with a preoperative Cobb angle >10°.

Excluded were: (i) not English; (ii) animal studies; (iii) review articles or letters to the editor; (iv) studies involving patients of age <40 years at the time of presentation; (v) studies involving patients with previous spine surgery or trauma, metabolic spinal pathology, asymmetrical anomalies at the lumbosacral junction, and a history of adolescent scoliosis or kyphosis, ankylosing spondylitis or osteoporotic vertebral fracture; (vi) studies involving patients with a preoperative Cobb angle ≤ 10°; (vii) studies that included nonsurgical treatment; (viii) studies with a duration of follow-up <2 years;.

16 studies included

Describe intervention:

D: posterior fusion and instrumentation

G: instrumented PLIF

H: treatment included lumbar spine fusion

J: posterior instrumented correction and fusion with additional anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF)

L: dynamic stabilization without fusion

M: radiculopathy; decompression alone, decompression and limited fusion, and decompression and full curve fusion

N: Healos graft carrier with bone marrow

aspirate and local autograft

O: decompression and instrumented arthrodesis

P: selective segmental transforaminal lumbar interbody fusion (TLIF)

.....

Describe control:

No control group, except for N: allograft

End-point of follow-up:

D: 3.8 yrs

G: 3.0 yrs

H: 2.0 yrs

J: 3.1 yrs

L: 4.5 yrs

M: 4.7 yrs

N: 2.0 yrs

O: 2.6 yrs

Mean <5 years

Outcome measure-1: Disability

Defined as ODI reduction

Effect measure: RR, RD, mean difference [95% CI]:

D: 17.2

G: pre 58, post 25,8= 32.2, reduction 56%

H: 20.6

J: 21.2

L: improvement 51,6%

M: 5.8

N:

group A: preop 77.6, postop 31.6=46, reduction 59%

group B: preop VAS 76.2, postop 32.7=43.5, reduction 57%

O: 20.2

Mean decrease was 23.3 +/- 11.3

Pain

L: 51,7% improvement leg pain; 57,8% back pain

N: back pain

group A: preop VAS 4.2, postop 3.6=0.6, reduction 14%

group B: preop VAS 4.2, postop 3.5=0.7, reduction 17%

Outcome measure-2: Complications

Overall complication rate was 49% (171 complications in 349 patients).

Study reference

Study characteristics

Patient characteristics ²

Intervention (I)

Comparison / control (C) ³

Follow-up

Outcome measures and effect size ⁴

Comments

Bridwell,

2009

Type of study: RCT

Setting: hospital

Country: USA

Source of funding: Corporate/Industry funds from Medtronic-Spinal Deformity Study Group

Inclusion criteria: age 40-80 yrs, primary presentation of spinal deformity with no cases prior operative treatment of the deformity

Exclusion criteria: unclear

N total at baseline:

Intervention: 89

Control: 167

Important prognostic factors²:

Age ± SD:

I:

C:

Sex:

I: % M

C: % M

Groups comparable at baseline?

Describe intervention (treatment/procedure/test):

Operation, not further specified

Describe control (treatment/procedure/test):

Nonoperative

Length of follow-up:

2 years

Loss-to-follow-up:

Intervention:

N (%): 4

Reasons (describe)

Control:

N (%): 86

Reasons (describe)

Outcome measures and effect size (include 95%CI and p-value if available):

Outcome measure-1 pain (delta NRS)

I: preoperative 3,89, postoperative 1,72 =2.17, reduction 62%

C:preoperative 3,68, postoperative 3,47 =0.21, reduction 6%

Clinically relevant

Outcome measure-2 function (delta ODI)

I: preoperative 34

Postoperative 20=41%

-14, reduction

C: preoperative 30

Postoperative 32

+2 7% increased

Clinically relevant

Study is sponsored, no RCT as there is no randomisation, high loss to follow-up in control group

No details about type of operation or conservative treatment

Liu,

2014

Type of study: prospective case series using the Spine Study Group database

Setting:

Country: USA

Source of funding:

Inclusion criteria: >18 yrs, spinal deformity (coronal cobb angle >20 degrees, sagittal vertical axis >5 cm, pelvic tilt>25 degrees, thoracic kyphosis >60 degrees

Exclusion criteria: -

N total at baseline:

Intervention: 239

Control: 225

Important prognostic factors²:

Age ± SD:

I: 56

C: 53

Sex:

I: 15% M

C: 14% M

Describe intervention (treatment/procedure/test):

Operation

Describe control (treatment/procedure/test):

Nonoperative treatment

Length of follow-up:

1 year

Loss-to-follow-up:

Only patients with complete follow-up and data were included

Outcome measures and effect size (include 95%CI and p-value if available):

Outcome measure-1 function (delta ODI)

I: preoperative 41.6, postoperative 28 =-13.6, reduction 33%

C: preoperative 25, postoperative 24.26=-0.74, reduction 3%

Clinically relevant

Complications not reported

Case series, no randomization

Study reference

Study characteristics

Patient characteristics ²

Intervention (I)

Comparison / control (C) ³

Follow-up

Outcome measures and effect size ⁴

Comments

Haque,

2014

Type of study: retrospective review of radiographic and clinical parameters of two multicenter databases for the surgical treatment of adult spinal deformity: a prospective open surgery database and a retrospective MIS and hybrid surgery database

Setting: hospital

Country: USA

Source of funding: see comments

Inclusion criteria:

1) Thirty-six-inch standing radiographs (preoperative, early postoperative, and last follow- up); 2) health-related quality of life measures pre- to postsurgery; 3) a Cobb angle greater than 20°; 4) at least 45 years of age; 5) fusion of 4 or more segments; and 6) a minimum 1-year follow-up.

Exclusion criteria:

deformity due to tumor, infection, and prior fusions greater than 2 levels (the latter exclusion criteria did not apply in the open group)

N total at baseline:

MIS: 42

Hybrid: 33

Open: 109

Important prognostic factors²:

age ± SD: 61.7 ± 8.4

Sex: 16 % M

Describe intervention (treatment/procedure/test):

Minimal invasive surgery (MIS)

Hybrid surgery

Instrumented spinal fusion

Describe control (treatment/procedure/test):

Open surgery

Length of follow-up:

Loss-to-follow-up:

The data were filtered to include only patients with pre- and postoperative radiographs: 184 out of 234 remained

Outcome measures and effect size (include 95%CI and p-value if available):

Outcome measure-1 pain (delta back pain measured by VAS scale)

MIS preoperative 6.2, postoperative 3.1= -3.1, reduction 50%

Hybrid: preoperative 7, postoperative 2.5=-4.5, reduction 64%

Open: preoperative7.1, postoperative 3.3=-3.8, reduction 53%

Differences not clin relevant

Outcome measure-2 pain (delta leg pain measured by VAS scale)

MIS: preoperative 4.4, postoperative 2.3= -2.1, reduction 47%

Hybrid: preoperative 4.6, postoperative 2.4=-2.2, reduction 48%

Open: preoperative 4.2, postoperative 2.4=-1.8, reduction 43%

Differences not clin relevant

Outcome measure-2 function (delta ODI)

MIS: preoperative 41.6, postoperative 23.3= -18.3, reduction 44%

Hybrid: preoperative 45.8, postoperative 29.4=-16.4, reduction 36%

Open: preoperative 41,1, postoperative 25,2=-15.9, reduction 39%

Differences not clin relevant

Outcome measure-3 Complications

I:early: 1 pulmonary infection and 1 epidural hematoma

C: early: 2 pulmonary infections, 1 deep wound infection, 2 transient neurologic dysfunction of the lower limbs

Complications (Major)*

MIS: 14%

Hybrid: 14%

Open: 45%

P=0.032

*= “Patient required reoperation, death, blindness, cardiac arrest, deep venous thrombosis, pulmonary embolism, implant failure, neurological deficit, pneumonia, sepsis, stroke, vascular injury, visceral injury, wound dehiscence, deep wound infection, hematoma formation with reoperation and proximal junctional kyphosis with reoperation

Dr. Mundis has served as a consultant to NuVasive and K2M, has received support of non–study-related clinical or research effort from NuVasive and ISSGF, and has received fellowship support from Pioneer, OREF, and NuVasive. Dr. Wang has served as a consultant to, and is a patent holder for, DePuy Spine. Dr. Mummaneni has direct stock ownership in Spinicity; has received royalties from DePuy Spine, Thieme Publishing, and Quality Medical Publishers; and has received honoraria from DePuy Spine and Globus. Dr. Uribe has served as a consultant to NuVasive. Dr. Okonkwo has received royalties from Lanx. Dr. Eastlack has direct stock ownership in NuVasive, Alphatec, DiFusion, and Invuity; has served as a consultant to NuVasive, Aesculap, Alphatec, and DePuy/Synthes; is a patent holder for Globus, Invuity, and NuTech; has received assistance for statistical analysis for study/writing or editorial assistance on manuscript from NuVasive; has received support of non–studyrelated clinical or research effort from Pioneer; and has served as a speaker for Eli Lilly. Dr. Anand is a patent holder for Medtronic, and has served as a consultant to Medtronic and Baxano Surgical. Dr. Kanter has received support of non–study-related clinical or research effort from NuVasive; and has received royalties from Lanx. Dr. La Marca has served as a consultant to Globus and Biomet, and has also received royalties from Globus. Dr. Park has served as a consultant to Globus and Medtronic, and has received royalties from Globus. Dr. Shaffrey has served as a consultant to Biomet, Globus, Medtronic, NuVasive, and Stryker, and is a patent holder for, and has received royalties from, Biomet and Medtronic. Dr. Klineberg has received fellowship grants from DePuy/Synthes and OREF, a research grant and speakers fees from AO Spine, and speaker’s fees from DePuy/Synthes and Stryker. Dr. Deviran has served as a consultant to NuVasive, Guidepoint, and Stryker.

Li,

2013

Type of study: RCT

Setting: hospital

Country: China

Source of funding: scientific research funds, health bureau of Zhejiang province, fund number 2008A096

Inclusion criteria: age greater than 40 years, Cobb’s angle between 20 degrees and 60 degrees, complaints of severe low back pain with or without neurologic symptoms, no response to at least 6 months of conservative treatment, and four or more affected vertebrae needing fusion

Exclusion criteria: structural thoracic curve, history of idiopathic scoliosis, earlier spinal fracture, severe vertebral deformity, presence of a strong continuous osteophyte at the anterior edge of the vertebral body, or severe osteoporosis

N total at baseline:

Intervention: 20

Control: 20

Important prognostic factors²:

Age ± SD:

I: 57 ± 10.8

C:55.2 ± 9.3

Sex:

I: 11 % M

C: 16 % M

Groups comparable at baseline? Operating time and estimated blood loss differed

Describe intervention (treatment/procedure/test):

PLIF

Describe control (treatment/procedure/test):

TLIF

Length of follow-up: 2-5 years, on average 3.2 years

Loss-to-follow-up:

2 lost, 1 died 2 years after surgery

Outcome measures and effect size (include 95%CI and p-value if available):

Outcome measure-1 pain (according to SR-22 questionnaire)

PLF: 3.48 +/- 0.54

TLIF: 3.91 +/- 0.62

Difference 11%, not clinically relevant

Outcome measure-2 function (delta ODI)

PLF: 3.25 +/- 0.69

TLIF: 3.45 +/- 0.61

Difference 6%, not clinically relevant

Outcome measure-3 Complications

PLF:early: 1 pulmonary infection and 1 epidural hematoma

TLIF: early: 2 pulmonary infections, 1 deep wound infection, 2 transient neurologic dysfunction of the lower limbs

(significantly more complications TLIF than PLF)

Sun, 2014

Type of study:

Setting: Hospital

Country: China

Source of funding: unknown

Inclusion criteria: osteoporose en history of disease 5-15 years -

Exclusion criteria: -

N total at baseline:

40

Important prognostic factors²:

For example

age ± SD: 68.7-year old

(range 60–77)

Sex: 35 % M

Groups comparable at baseline?

Describe intervention (treatment/procedure/test):

First group:

they were treated with limited decompression, intervertebral fusion, and short-segmental fixation in situ. Locally hypertrophic ligamentum flavum and upper and inferior zygopophysis with hyperplasia and cohesion were cleaned as much as possible during decompression. The application of bone grating between vertebral plates was determined by specific surgical condition and amount of crushbone

Describe control (treatment/procedure/test):

Second group:

treated with sufficient decompression, orthopedic bone graft fusion, and internal fixation. Whole vertebral plate of the most severe lateral curvature part was removed; nucleus pulposus of corresponding section was also removed; fibrous scar tissue and

hypertrophic ligamentum flavum were thoroughly cleaned; superior and inferior zygopophysis with hypertrophy and cohesion were removed. Pedicle screw was placed, and orthopedic bar was installed in patients who needed internal fixation evaluated before surgery. Concave side strut, protrude side compression, de-rotation technology, and spondylolisthesis reduction techniques were applied to reconstruct three- dimensional balance of spine

Length of follow-up: All patients completed the follow-up period for more than 1 year, with the average of 18 months

Outcome measures and effect size (include 95%CI and p-value if available):

Outcome measure-1 pain: (Waist and back pain remission

Rate (Waist and back pain remission rate = (preoperative VAS - postoperative VAS)/preoperative VAS 9 100 %)))

First group 72.5% reduction

Second group 75.2% reduction

Difference not clinically relevant

Outcome measure-2 function (delta ODI)

ODI index improvement rate = (preoperative ODI – postoperative ODI) / preoperative ODI 9 100 %

First group: reduction 61%

Second group: reduction 83%

Difference between groups 22%

Outcome measure-3 Complications

3 patients were

unstable after surgery, transferred to Intensive Care Unit, and relieved there. There was no leakage of cerebrospinal fluid in Group 1, but 4 patients had leakage of cerebrospinal fluid in Group 2 and were discharged after conservative treatment.