Perioperative Recovery Kinetics and Narcotic Use Following Circumferential minimal invasive surgery (CMIS) for Adult Spinal Deformity Correction of 6 or more levels

Introduction: CMIS for ASD avoids extensive muscle dissections and osteotomies to achieve optimal alignment. Therefore, it is conceivable that patients would ambulate early after surgery and would need fewer narcotic medications. It is important to objectively quantify these parameters to better understand cMIS outcomes.

Methods: A prospectively maintained registry of patients undergoing 6+ levels thoracolumbar cMIS for ASD from Jan2011 to Dec2023 was retrospectively analyzed. Total number of steps ambulated in the postop period and the morphine equivalent (MME) of narcotics administered were calculated in the postoperative period and for up to 3 months after surgery.

Results: A total of 133patients were identified. No patient required ICU admission. 126 patients (95%) were able to stand between the stage 1 and 2 of the cMIS. 71 (53.3%) and 106 (80%) patients were able to stand upright by post-op day 1 (POD 1) and 2 {days denoted after second stage}, respectively. By POD 3, at least 99 patients (74%) of patients had walked at least 25 feet and 65pts(49%) has walked at least 50ft. Out of 62patients who were taking narcotics pre-operatively, only 22(35%) were taking any narcotics at 3months post-op. The patients needing narcotics decreased from 124(93%,average MME 89.7) on POD 1 to 36patients (27%) on POD 7 (average47.3MME). At 2week FU, 57patients (43 %) were completely off narcotic medications, and the rest 76(57%)patients narcotics use decreased to 13.6MME on average. At the 3month follow up, 94patients(71%) were completely off narcotics, and 39patients(29%) had decreased use to an average of 4.8MME (95% decrease from POD 1).

Conclusion : Utilizing cMIS for ASD probably helps in early mobility and less use of narcotic pain medications post-surgery. These advantages of cMIS could minimize complications associated with hospital stay and improves functional outcomes in the early postoperative phase. This possibly makes cMIS a more favorable option for the elderly population and patients with comorbidities.