Reoperation rates in minimally invasive, hybrid and open surgical treatment for adult spinal deformity with minimum 2-year follow-up

OBJECTIVE Previous studies have demonstrated the short-term radiographic and clinical benefits of circumferential minimally invasive surgery (cMIS) and hybrid (i.e., minimally invasive anterior or lateral interbody fusion with an open posterior approach) techniques to correct adult spinal deformity (ASD). However, it is not known if these benefits are maintained over longer periods of time. This study evaluated the 2- and 3-year outcomes of cMIS and hybrid correction of ASD. METHODS A multicenter database was retrospectively reviewed for patients undergoing cMIS or hybrid surgery for ASD. Patients were ≥ 18 years of age and had one of the following: maximum coronal Cobb angle (CC) ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic incidence–lumbar lordosis mismatch (PI-LL) ≥ 10°, or pelvic tilt (PT) > 20°. Radiographic parameters were evaluated at the latest follow-up. Clinical outcomes were compared at 2- and 3-year time points and adjusted for age, preoperative CC, levels operated, levels with interbody fusion, presence of L5–S1 anterior lumbar interbody fusion, and upper and lower instrumented vertebral level. RESULTS Overall, 197 (108 cMIS, 89 hybrid) patients were included with 187 (99 cMIS, 88 hybrid) and 111 (60 cMIS, 51 hybrid) patients evaluated at 2 and 3 years, respectively. The mean (± SD) follow-up duration for cMIS (39.0 ± 13.3 months, range 22–74 months) and hybrid correction (39.9 ± 16.8 months, range 22–94 months) were similar for both cohorts. Hybrid procedures corrected the CC greater than the cMIS technique (adjusted p = 0.022). There were no significant differences in postoperative SVA, PI-LL, PT, and sacral slope (SS). At 2 years, cMIS had lower Oswestry Disability Index (ODI) scores (adjusted p < 0.001), greater ODI change as a percentage of baseline (adjusted p = 0.006), less visual analog scale (VAS) back pain (adjusted p = 0.006), and greater VAS back pain change as a percentage of baseline (adjusted p = 0.001) compared to hybrid techniques. These differences were no longer significant at 3 years. At 3 years, but not 2 years, VAS leg pain was lower for cMIS compared to hybrid techniques (adjusted p = 0.032). Those undergoing cMIS had fewer overall complications compared to hybrid techniques (adjusted p = 0.006), but a higher odds of pseudarthrosis (adjusted p = 0.039). CONCLUSIONS In this review of a multicenter database for patients undergoing cMIS and hybrid surgery for ASD, hybrid procedures were associated with a greater CC improvement compared to cMIS techniques. cMIS was associated with superior ODI and back pain at 2 years, but this difference was no longer evident at 3 years. However, cMIS was associated with superior leg pain at 3 years. There were fewer complications following cMIS, with the exception of pseudarthrosis.

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Patient outcomes after circumferential minimally invasive surgery compared with those of open correction for adult spinal deformity: initial analysis of prospectively collected data

Journal of Neurosurgery Spine ◽

10.3171/2021.3.spine201825 ◽

2021 ◽

pp. 1-12

Author(s):

Dean Chou ◽

Virginie Lafage ◽

Alvin Y. Chan ◽

Peter Passias ◽

Gregory M. Mundis ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Spinal Deformity ◽

Interbody Fusion ◽

Pelvic Incidence ◽

Adult Spinal Deformity ◽

Adult Scoliosis ◽

Propensity Matching ◽

Surgery Rates

OBJECTIVE Circumferential minimally invasive spine surgery (cMIS) for adult scoliosis has become more advanced and powerful, but direct comparison with traditional open correction using prospectively collected data is limited. The authors performed a retrospective review of prospectively collected, multicenter adult spinal deformity data. The authors directly compared cMIS for adult scoliosis with open correction in propensity-matched cohorts using health-related quality-of-life (HRQOL) measures and surgical parameters. METHODS Data from a prospective, multicenter adult spinal deformity database were retrospectively reviewed. Inclusion criteria were age > 18 years, minimum 1-year follow-up, and one of the following characteristics: pelvic tilt (PT) > 25°, pelvic incidence minus lumbar lordosis (PI-LL) > 10°, Cobb angle > 20°, or sagittal vertical axis (SVA) > 5 cm. Patients were categorized as undergoing cMIS (percutaneous screws with minimally invasive anterior interbody fusion) or open correction (traditional open deformity correction). Propensity matching was used to create two equal groups and to control for age, BMI, preoperative PI-LL, pelvic incidence (PI), T1 pelvic angle (T1PA), SVA, PT, and number of posterior levels fused. RESULTS A total of 154 patients (77 underwent open procedures and 77 underwent cMIS) were included after matching for age, BMI, PI-LL (mean 15° vs 17°, respectively), PI (54° vs 54°), T1PA (21° vs 22°), and mean number of levels fused (6.3 vs 6). Patients who underwent three-column osteotomy were excluded. Follow-up was 1 year for all patients. Postoperative Oswestry Disability Index (ODI) (p = 0.50), Scoliosis Research Society–total (p = 0.45), and EQ-5D (p = 0.33) scores were not different between cMIS and open patients. Maximum Cobb angles were similar for open and cMIS patients at baseline (25.9° vs 26.3°, p = 0.85) and at 1 year postoperation (15.0° vs 17.5°, p = 0.17). In total, 58.3% of open patients and 64.4% of cMIS patients (p = 0.31) reached the minimal clinically important difference (MCID) in ODI at 1 year. At 1 year, no differences were observed in terms of PI-LL (p = 0.71), SVA (p = 0.46), PT (p = 0.9), or Cobb angle (p = 0.20). Open patients had greater estimated blood loss compared with cMIS patients (1.36 L vs 0.524 L, p < 0.05) and fewer levels of interbody fusion (1.87 vs 3.46, p < 0.05), but shorter operative times (356 minutes vs 452 minutes, p = 0.003). Revision surgery rates between the two cohorts were similar (p = 0.97). CONCLUSIONS When cMIS was compared with open adult scoliosis correction with propensity matching, HRQOL improvement, spinopelvic parameters, revision surgery rates, and proportions of patients who reached MCID were similar between cohorts. However, well-selected cMIS patients had less blood loss, comparable results, and longer operative times in comparison with open patients.

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Total Hospital Costs of Surgical Treatment for Adult Spinal Deformity: An Extended Follow-Up Study

The Spine Journal ◽

10.1016/j.spinee.2013.07.259 ◽

2013 ◽

Vol 13 (9) ◽

pp. S95-S96

Author(s):

Ian McCarthy ◽

Michael O’Brien ◽

Christopher P. Ames ◽

Han Jo Kim ◽

Justin S. Smith ◽

...

Keyword(s):

Surgical Treatment ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Hospital Costs ◽

Total Hospital ◽

Follow Up Study

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Revision Surgery Rates After Minimally Invasive Adult Spinal Deformity Surgery: Correlation with Roussouly Spine Type at 2-Year Follow-Up?

World Neurosurgery ◽

10.1016/j.wneu.2021.01.011 ◽

2021 ◽

Author(s):

Dean Chou ◽

Alvin Y. Chan ◽

Paul Park ◽

Robert K. Eastlack ◽

Kai-Ming Fu ◽

...

Keyword(s):

Minimally Invasive ◽

Spinal Deformity ◽

Revision Surgery ◽

Adult Spinal Deformity ◽

Spinal Deformity Surgery ◽

Surgery Rates

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Minimally Invasive Pedicle Subtraction Osteotomy via Tubular Retractor for Adult Rigid Spinal Kyphoscoliosis: a Case Report and Review of the Literature

10.21203/rs.3.rs-138937/v1 ◽

2021 ◽

Author(s):

ZeJun Xing ◽

Zhuo Ma ◽

Xun Ma

Keyword(s):

Minimally Invasive ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Pedicle Subtraction Osteotomy ◽

Process Time ◽

X Rays ◽

Tubular Retractor ◽

Proper Patient Selection ◽

Estimated Blood Loss

Abstract Objective To describe a new technique, minimally invasive pedicle subtraction osteotomy (MIS PSO) via tubular retractor, for severe rigid adult spinal deformity.Methods We present a case with severe rigid thoracolumbar kyphoscoliosis and describe the surgical procedure , to which this patient responded favorably.Results No surgical complications were seen and estimated blood loss was 600ml. The operation process time was about 5 hours. She received 2 unit of packed red blood cells intraoperatively. VAS was 8.5 points at pre-operation and 2 .0 points at 2 years follow-up. The ODI score improved from 33 to 9. Fusion was confirmed by wedging of L2 vertebral body on CT reconstructive films. Routine x-rays showed that spinal imbalance was corrected and maintained at the final follow up. Maximal ambulation distance increased to 5000 feet at 2 years follow-up.Conclusion A MIS PSO is a feasible option for the treatment of certain subtypes of adult spinal deformity. It is technically feasible that although limited by learning curve of minimally invasive tubular technique and open PSO technique. Both operation skill of the surgeons and proper patient selection is the key to successfully treating adult patients with deformity using MIS PSO.

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Patients with High Pelvic Tilt Achieve the Same Clinical Success as Those with Low Pelvic Tilt After Minimally Invasive Adult Deformity Surgery

Neurosurgery ◽

10.1093/neuros/nyx383 ◽

2017 ◽

Vol 83 (2) ◽

pp. 270-276 ◽

Cited By ~ 2

Author(s):

Juan S Uribe ◽

Jacob Januszewski ◽

Michael Wang ◽

Neel Anand ◽

David O Okonkwo ◽

...

Keyword(s):

Minimally Invasive ◽

Spinal Deformity ◽

Pelvic Tilt ◽

Adult Spinal Deformity ◽

Vertical Axis ◽

Sagittal Vertical Axis ◽

Adult Deformity ◽

Radiographic Outcomes ◽

Hrqol Data

Abstract BACKGROUND Pelvic tilt (PT) is a compensatory mechanism for adult spinal deformity patients to mitigate sagittal imbalance. The association between preop PT and postop clinical and radiographic outcomes has not been well studied in patients undergoing minimally invasive adult deformity surgery. OBJECTIVE To evaluate clinical and radiographic outcomes in adult spinal deformity patients with high and low preoperative PT treated surgically using less invasive techniques. METHODS Retrospective case-control, institutional review board-approved study. A multicenter, minimally invasive surgery spinal deformity patient database was queried for 2-yr follow-up with complete radiographic and health-related quality of life (HRQOL) data. Hybrid surgery patients were excluded. Inclusion criteria were as follows: age > 18 and either coronal Cobb angle > 20, sagittal vertical axis > 5 cm, pelvic incidence-lumbar lordosis (PI-LL) > 10 or PT > 20. Patients were stratified by preop PT as per Schwab classification: low (PT< 20), mid (PT 20-30), or high (>30). Postoperative radiographic alignment parameters (PT, PI, LL, Cobb angle, sagittal vertical axis) and HRQOL data (Visual Analog Scale Back/Leg, Oswestry Disability Index) were evaluated and analyzed. RESULTS One hundred sixty-five patients had complete 2-yr outcomes data, and 64 patients met inclusion criteria (25 low, 21 mid, 18 high PT). High PT group had higher preop PI-LL mismatch (32.1 vs 4.7; P < .001). At last follow-up, 76.5% of patients in the high PT group had continued PI-LL mismatch compared to 34.8% in the low PT group (P < .006). There was a difference between groups in terms of postop changes of PT (–3.9 vs 1.9), LL (8.7 vs 0.5), and PI-LL (–9.5 vs 0.1). Postoperatively, HRQOL data (Oswestry Disability Index and Visual Analog Scale) were significantly improved in both groups (P < .001). CONCLUSION Adult deformity patients with high preoperative PT treated with minimally invasive surgical techniques had less radiographic success but equivalent clinical outcomes as patients with low PT.

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Surgical Treatment for Adult Spinal Deformity: A Comparison of Cost Effectiveness and Clinical Effectiveness at Five-Year and Eight-Year Follow-Up

The Spine Journal ◽

10.1016/j.spinee.2017.08.108 ◽

2017 ◽

Vol 17 (10) ◽

pp. S223-S224

Author(s):

Samrat Yeramaneni ◽

Amit Jain ◽

Jeffrey L. Gum ◽

Michael P. Kelly ◽

Steven D. Glassman ◽

...

Keyword(s):

Cost Effectiveness ◽

Surgical Treatment ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Clinical Effectiveness

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Comparison of two minimally invasive surgery strategies to treat adult spinal deformity

Journal of Neurosurgery Spine ◽

10.3171/2014.9.spine131004 ◽

2015 ◽

Vol 22 (4) ◽

pp. 374-380 ◽

Cited By ~ 58

Author(s):

Paul Park ◽

Michael Y. Wang ◽

Virginie Lafage ◽

Stacie Nguyen ◽

John Ziewacz ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Cobb Angle ◽

Invasive Surgery ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Significant Difference ◽

Vas Scores ◽

The Mean

OBJECT Minimally invasive surgery (MIS) techniques are becoming a more common means of treating adult spinal deformity (ASD). The aim of this study was to compare the hybrid (HYB) surgical approach, involving minimally invasive lateral interbody fusion with open posterior instrumented fusion, to the circumferential MIS (cMIS) approach to treat ASD. METHODS The authors performed a retrospective, multicenter study utilizing data collected in 105 patients with ASD who were treated via MIS techniques. Criteria for inclusion were age older than 45 years, coronal Cobb angle greater than 20°, and a minimum of 1 year of follow-up. Patients were stratified into 2 groups: HYB (n = 62) and cMIS (n = 43). RESULTS The mean age was 60.7 years in the HYB group and 61.0 years in the cMIS group (p = 0.910). A mean of 3.6 interbody fusions were performed in the HYB group compared with a mean of 4.0 interbody fusions in the cMIS group (p = 0.086). Posterior fusion involved a mean of 6.9 levels in the HYB group and a mean of 5.1 levels in the cMIS group (p = 0.003). The mean follow-up was 31.3 months for the HYB group and 38.3 months for the cMIS group. The mean Oswestry Disability Index (ODI) score improved by 30.6 and 25.7, and the mean visual analog scale (VAS) scores for back/leg pain improved by 2.4/2.5 and 3.8/4.2 for the HYB and cMIS groups, respectively. There was no significant difference between groups with regard to ODI or VAS scores. For the HYB group, the lumbar coronal Cobb angle decreased by 13.5°, lumbar lordosis (LL) increased by 8.2°, sagittal vertical axis (SVA) decreased by 2.2 mm, and LL–pelvic incidence (LL-PI) mismatch decreased by 8.6°. For the cMIS group, the lumbar coronal Cobb angle decreased by 10.3°, LL improved by 3.0°, SVA increased by 2.1 mm, and LL-PI decreased by 2.2°. There were no significant differences in these radiographic parameters between groups. The complication rate, however, was higher in the HYB group (55%) than in the cMIS group (33%) (p = 0.024). CONCLUSIONS Both HYB and cMIS approaches resulted in clinical improvement, as evidenced by decreased ODI and VAS pain scores. While there was no significant difference in degree of radiographic correction between groups, the HYB group had greater absolute improvement in degree of lumbar coronal Cobb angle correction, increased LL, decreased SVA, and decreased LL-PI. The complication rate, however, was higher with the HYB approach than with the cMIS approach.

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