{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T02:19:44Z","timestamp":1785809984693,"version":"3.56.0"},"reference-count":9,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2016,7]]},"abstract":"\nOBJECTIVE<\/jats:title>\nMinimally invasive surgery (MIS) techniques are increasingly used to treat adult spinal deformity. However, standard minimally invasive spinal deformity techniques have a more limited ability to restore sagittal balance and match the pelvic incidence\u2013lumbar lordosis (PI-LL) than traditional open surgery. This study sought to compare \u201cbest\u201d versus \u201cworst\u201d outcomes of MIS to identify variables that may predispose patients to postoperative success.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nA retrospective review of minimally invasive spinal deformity surgery cases was performed to identify parameters in the 20% of patients who had the greatest improvement in Oswestry Disability Index (ODI) scores versus those in the 20% of patients who had the least improvement in ODI scores at 2 years' follow-up.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nOne hundred four patients met the inclusion criteria, and the top 20% of patients in terms of ODI improvement at 2 years (best group, 22 patients) were compared with the bottom 20% (worst group, 21 patients). There were no statistically significant differences in age, body mass index, pre- and postoperative Cobb angles, pelvic tilt, pelvic incidence, levels fused, operating room time, and blood loss between the best and worst groups. However, the mean preoperative ODI score was significantly higher (worse disability) at baseline in the group that had the greatest improvement in ODI score (58.2 vs 39.7, p < 0.001). There was no difference in preoperative PI-LL mismatch (12.8\u00b0 best vs 19.5\u00b0 worst, p = 0.298). The best group had significantly less postoperative sagittal vertical axis (SVA; 3.4 vs 6.9 cm, p = 0.043) and postoperative PI-LL mismatch (10.4\u00b0 vs 19.4\u00b0, p = 0.027) than the worst group. The best group also had better postoperative visual analog scale back and leg pain scores (p = 0.001 and p = 0.046, respectively).<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nThe authors recommend that spinal deformity surgeons using MIS techniques focus on correcting a patient's PI-LL mismatch to within 10\u00b0 and restoring SVA to < 5 cm. Restoration of these parameters seems to impact which patients will attain the greatest degree of improvement in ODI outcomes, while the spines of patients who do the worst are not appropriately corrected and may be fused into a fixed sagittal plane deformity.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.12.spine15999","type":"journal-article","created":{"date-parts":[[2016,3,4]],"date-time":"2016-03-04T15:02:02Z","timestamp":1457103722000},"page":"21-25","source":"Crossref","is-referenced-by-count":49,"title":["Clinical and radiographic parameters associated with best versus worst clinical outcomes in minimally invasive spinal deformity surgery"],"prefix":"10.3171","volume":"25","author":[{"given":"Khoi D.","family":"Than","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Ming","family":"Fu","sequence":"additional","affiliation":[{"name":"Weill Cornell Brain and Spine Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacie","family":"Nguyen","sequence":"additional","affiliation":[{"name":"San Diego Center for Spinal Disorders, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"University of Miami Spine Institute, Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierce D.","family":"Nunley","sequence":"additional","affiliation":[{"name":"Spine Institute of Louisiana, Shreveport, Louisiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neel","family":"Anand","sequence":"additional","affiliation":[{"name":"Orthopedic Spine Surgery, Cedars-Sinai, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard G.","family":"Fessler","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Rocky Mountain Scoliosis & Spine, Denver, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behrooz A.","family":"Akbarnia","sequence":"additional","affiliation":[{"name":"San Diego Center for Spinal Disorders, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedat","family":"Deviren","sequence":"additional","affiliation":[{"name":"Spine Center, UCSF Medical Center, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan S.","family":"Uribe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"La Marca","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam S.","family":"Kanter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Okonkwo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory M.","family":"Mundis","sequence":"additional","affiliation":[{"name":"San Diego Center for Spinal Disorders, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery 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