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Kelly et al. [4] found that patients undergoing VCR were more likely to suffer from a perioperative complication compared to those who underwent PSO (VCR: 73.7% vs. PSO: 46.9%, p=0.03). Auerbach et al. [1] found the opposite trend; a higher rate of minor complications (PSO: 53% vs. VCR: 28%, p=0.07) and complications requiring revision (PSO: 20% vs. VCR: 0%, p=0.07) in the PSO group. Hassanzadeh et al. [5] reported a higher rate of major complications following VCR (VCR: 4/15, 26.7% vs. PSO: 5/38, 13.2%) but this was not significant (p=0.42). Finally, Scheer et al. [3] reported that VCR did not have an increased rate of intraoperative (p>0.05) or postoperative (p>0.05) complications compared to PSO when stratified by age group. They did not perform an analysis Selleck CX 5461 of the overall rate of complications, i.e., intraoperative and postoperative complications. The data above was pooled to calculate an overall relative risk of complications for VCR vs. PSO. Results of this analysis are shown in Fig. 2. Analysis of the pooled data revealed a significantly higher rate of all complications with VCR vs. PSO (VCR: 87.4%, PSO: 64.3%, RR: 1.36, 95% CI: 1.24�C1.49, pDipivefrine column resection; PSO, pedicle ... 4. Clinical outcomes Four studies reported clinical outcomes, which uniformly improved following VCR [1,3,9,12]. The results are summarized in Table 5. Scheer et al. [3] sought to examine the impact of age on clinical outcomes. They reported the change in the 36-Item Short-Form Health Survey (SF-36, Physical Component Summary [PCS] and Mental Component Summary [MCS]), visual analog scale (VAS), Oswestry disability index (ODI) selleck kinase inhibitor and the Scoliosis Research Society-22 questionnaire (SRS-22, subdomains: activity, pain, satisfaction, mental, appearance and total). In their series of all 3COs, they were able to show a significant improvement between preoperative and postoperative scores for all of the above measures [3]. Compared to older patients (age ��65 years), young patients (age ��45 years) undergoing VCR had greater improvement and were more likely to meet MCID in 2-year SRS pain, SRS function, 1-year PCS and 2-year PCS scores [3]. Table 5 Studies reporting clinical outcome measures for patients undergoing VCR Auerbach et al. [1] evaluated patients using the SRS-24 instrument (subdomains: pain, function, self-image, total subscore). The clinical outcomes still improved even if patients experienced a complication. Wang et al. [9] showed a significant improvement in VAS from 1.8��2.2 to 0.5��1.1 (p