Minimally Invasive Osteotomies for Adult Deformity

2021 ◽  
pp. 100891
Author(s):  
Neel Anand ◽  
Andrew Chung
Keyword(s):  
Minimally Invasive ◽  
Adult Deformity

Adult Deformity Correction Through Minimally Invasive Lateral Approach Techniques

Spine ◽  
2010 ◽  
Vol 35 (Supplement) ◽  
pp. S312-S321 ◽  
Author(s):  
Gregory M. Mundis ◽  
Behrooz A. Akbarnia ◽  
Frank M. Phillips
Keyword(s):  
Minimally Invasive ◽  
Deformity Correction ◽  
Lateral Approach ◽  
Adult Deformity

Proximal fusion constructs in minimally invasive scoliosis surgery are successful without interbody or intertransverse fusion

2019 ◽  
Vol 31 (6) ◽  
pp. 851-856
Author(s):  
S. Shelby Burks ◽  
Juan S. Uribe ◽  
John Paul G. Kolcun ◽  
Adisson Fortunel ◽  
Jakub Godzik ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Deformity Correction ◽  
Scoliosis Surgery ◽  
Inclusion Criteria ◽  
Female Ratio ◽  
Adult Deformity ◽  
Male Female Ratio ◽  
Invasive Techniques

OBJECTIVEMinimally invasive techniques are increasingly used in adult deformity surgery as surgeon familiarity improves and long-term data are published. Concerns raised in such cases include pseudarthrosis at levels where interbody grafts are not utilized. Few previous studies have specifically examined the thoracolumbar component of long surgical constructs, which is commonly instrumented without interbody or intertransverse fusion.METHODSA retrospective analysis was performed on all patients who underwent hybrid minimally invasive deformity corrections in two academic spine centers over a 9-year period. Inclusion criteria were at least 2 rostral levels instrumented percutaneously, ranging from T8 to L1 as the upper end of the construct. Fusion assessment was made using CT when possible or radiography. Common radiographic parameters and clinical variables were assessed pre- and postoperatively.RESULTSA total of 36 patients fit the inclusion criteria. Baseline characteristics included a 1:1.8 male/female ratio, average age of 65.7 years, and BMI of 30.2 kg/m2. Follow-up imaging was obtained at a mean of 35.7 months. The average number of levels fused was 7.5, with an average of 3.4 instrumented percutaneously between T8 and L1, representing a total of 120 rostral levels instrumented percutaneously. Fusion assessment was performed using CT in 69 levels and radiography in 51 levels. Among the 120 rostral levels instrumented percutaneously, robust fusion was noted in 25 (20.8%), with 53 (44.2%) exhibiting some evidence of fusion. Pseudarthrosis was noted in 2 rostral segments (1.7%). There were no instances of proximal hardware revision. Eight patients exhibited radiographic proximal junctional kyphosis (PJK; 22.2%), none of whom underwent surgical intervention.CONCLUSIONSIn the present series of adult patients with scoliosis undergoing thoracolumbar deformity correction, rostral segments instrumented percutaneously have a very low rate of pseudarthrosis, with radiographic evidence of bone fusion occurring in more than 60% of patients. The rate of PJK was acceptable and similar to other published series.

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

Neurosurgery ◽  
2017 ◽  
Vol 83 (2) ◽  
pp. 270-276 ◽  
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.

scholarly journals Treatment of Adult Scoliosis Fractional Curve With Minimally Invasive Surgery: Anterior Versus Posterior Approach?

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Robert Eastlack ◽  
Juan S Uribe ◽  
Richard G Fessler ◽  
Khoi D Than ◽  
Stacie Tran ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Posterior Approach ◽  
Interbody Fusion ◽  
Deformity Correction ◽  
Adult Scoliosis ◽  
Hybrid Technique ◽  
Complication Rates ◽  
Adult Deformity ◽  
Curve Magnitude

Abstract INTRODUCTION The fractional curve in adult scoliosis often causes radiculopathy and may be managed in varied manners with minimally invasive (MIS) deformity correction. There are inherent risks and benefits to anterior and posterior interbody reconstruction techniques, and the purpose of this study was to evaluate for differences in outcomes or complication rates by fractional curve treatment via MIS anterior vs. posterior interbody fusion METHODS Inclusion criteria were age = 18 yr, and one of the following: coronal cobb > 20°, SVA > 5 cm, PT > 20°, PI-LL > 10°. Patients were treated with circumferential MIS (cMIS) surgery or hybrid MIS surgery and had 2-yr minimum follow-up. Patient were divided into two groups: anterior or posterior interbody fusion at the lumbosacral junction (L4-S1). HRQOL measures included Oswestry Disability Index (ODI), visual analog score (VAS). RESULTS A total of 112 patients who underwent MIS adult deformity surgery with minimum 2-yr follow up. A total of 74 patients underwent anterior and 38 patients underwent posterior interbody reconstruction at L4-S1 utilizing MIS technique. Preoperative spinopelvic parameters, radiographic parameters, and VAS were not different, but ODI was higher in the anterior group (53 vs 48, P = .047). Complications and reoperation rates were not different (P = .089, P = .597), but posterior had more infections (15.8% vs 2.7%, P = .01). When subdivided for cMIS only surgery, 38 had anterior and 19 underwent posterior interbody fusions in the fractional curve. Pre- and postoperative VAS leg, ODI, and fractional curve magnitude were not different. In the anterior surgery cohorts, laminectomies at L4-S1 were performed in 22% of hybrid cases and in 8% of cMIS cases. CONCLUSION Treatment of the fractional curve of adult scoliosis appears to be similarly effective in reducing VAS, ODI, and fractional curve magnitude regardless of anterior vs posterior approach. However, posterior interbody reconstruction was associated with higher infection rate than anterior, regardless of application in cMIS or hybrid technique.

Considerations in Dysphagia Management Following Esophagectomy

2016 ◽  
Vol 1 (13) ◽  
pp. 169-176
Author(s):  
Lisa M. Evangelista ◽  
James L. Coyle
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Surgical Procedures ◽  
Esophageal Resection ◽  
Minimally Invasive Surgical ◽  
Operative Complications ◽  
Swallowing Difficulties ◽  
Epidemiological Impact ◽  
Invasive Techniques ◽  
Management Of Dysphagia

Esophageal cancer is the sixth leading cause of death from cancer worldwide. Esophageal resection is the mainstay treatment for cancers of the esophagus. While curative, surgical resection may result in swallowing difficulties that require intervention from speech-language pathologists (SLPs). Minimally invasive surgical procedures for esophageal resection have aimed to reduce morbidity and mortality associated with more invasive techniques. Both intra-operative and post-operative complications, regardless of the surgical approach, can result in dysphagia. This article will review the epidemiological impact of esophageal cancers, operative complications resulting in dysphagia, and clinical assessment and management of dysphagia pertinent to esophageal resection.

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