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

2015 ◽  
Vol 22 (4) ◽  
pp. 374-380 ◽  
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.

scholarly journals Improvement of sagittal balance and lumbar lordosis following less invasive adult spinal deformity surgery with expandable cages and percutaneous instrumentation

2013 ◽  
Vol 18 (1) ◽  
pp. 4-12 ◽  
Author(s):  
Michael Y. Wang
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Spinal Deformity ◽  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Surgical Methods ◽  
The Mean ◽  
Expandable Cages

Object The treatment of adult spinal deformity (ASD) remains a challenge for the spine surgeon. While minimally invasive surgery (MIS) has many favorable attributes that would be of great benefit for the ASD population, improvements in lordosis and sagittal balance have remained elusive in cases involving the MIS approach. This report describes the evolution of an MIS method for treating ASD with attention to sagittal correction. Methods Over an 18-month period 25 patients with thoracolumbar scoliosis were treated surgically. The mean patient age was 72 years, and 68% of the population was female. Patients were treated with multilevel facet osteotomies and interbody fusion in which expandable cages (mean 3.2 levels) were placed and percutaneous screw fixation (mean 5.3 levels) was performed. Seven patients underwent supplemental percutaneous iliac fixation. Results All patients underwent MIS without conversion to a traditional open procedure. The mean operative time was 273 mins and the mean blood loss was 416 ml. There were no intraoperative complications. The Cobb angle over the scoliotic deformity improved from a mean of 29.2° to that of 9.0° (p < 0.001). Lumbar lordosis between L-1 and S-1 improved from a mean of 27.8° to one of 42.6° (p < 0.001). Sagittal vertical axis improved from 7.4 cm to 4.3 cm (p = 0.001). Numeric pain scale scores improved as well, an average of 3.3 and 4.2 for the leg and back, respectively. A mean improvement of 20.8 points on the Oswestry Disability Index was seen at 12 months. Complications included: two cases requiring hardware repositioning, one case of screw pullout, one asymptomatic pedicle screw breach, prolonged hospitalization from constipation, and one acute coronary syndrome developing 3 days after surgery without myocardial damage. Conclusions An expanding body of evidence suggests that sagittal balance remains a keystone for good outcomes after ASD surgery. Minimally invasive surgery that involves a combination of osteotomies, interbody height restoration, and advanced fixation techniques may achieve this goal in patients with less severe deformities. While feasibility will have to be proven with larger series and improved surgical methods, the present technique holds promise as a means of reducing the significant morbidity associated with surgery in the ASD population.

Clinical and radiological outcomes of minimally-invasive surgery for adolescent idiopathic scoliosis at a minimum two years’ follow-up

2020 ◽  
Vol 102-B (4) ◽  
pp. 506-512 ◽  
Author(s):  
Charlotte de Bodman ◽  
Alexandre Ansorge ◽  
Anne Tabard-Fougère ◽  
Nicolas Amirghasemi ◽  
Romain Dayer
Keyword(s):  
Minimally Invasive Surgery ◽  
Adolescent Idiopathic Scoliosis ◽  
Minimally Invasive ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Invasive Surgery ◽  
Complication Rate ◽  
Posterior Approach ◽  
The Mean

Aims The direct posterior approach with subperiosteal dissection of the paraspinal muscles from the vertebrae is considered to be the standard approach for the surgical treatment of adolescent idiopathic scoliosis (AIS). We investigated whether or not a minimally-invasive surgery (MIS) technique could offer improved results. Methods Consecutive AIS patients treated with an MIS technique at two tertiary centres from June 2013 to March 2016 were retrospectively included. Preoperative patient deformity characteristics, perioperative parameters, power of deformity correction, and complications were studied. A total of 93 patients were included. The outcome of the first 25 patients and the latter 68 were compared as part of our safety analysis to examine the effect of the learning curve. Results In the first 25 cases, with a mean follow-up of 5.6 years (standard deviation (SD) 0.4), the mean preoperative major Cobb angle was 57.6° (SD 9.8°) and significantly corrected to mean 15.4° (SD 5.6°, 73% curve correction). The mean preoperative T5-T12 was 26.2 (SD 12.8) and significantly increased to mean 32.9 (SD 8.3). Both frontal and sagittal plane correction was conserved two years after surgery. The rate of perioperative complications was 12% and three further complications occurred (three deep delayed infection). In the latter cases, 68 patients were included with a mean follow-up time of three years (SD 0.6). The mean preoperative major Cobb angle was 58.4° (SD 9.2°) and significantly corrected to mean 20.4° (SD 7.3°).The mean preoperative T5-T12 kyphosis was 26.6° (SD 12.8°) and was significantly increased to mean 31.4° (SD 8.3°). Both frontal and sagittal correction was conserved two years after surgery. The perioperative (30 day) complication rate was 1.4%. Two (2.9%) additional complications occurred in two patients. Conclusion MIS for AIS is associated with a significant correction of spine deformity in the frontal and sagittal planes, together with low estimated blood loss and short length of stay. The perioperative complication rate seems to be lower compared with the standard open technique based on the literature data. The longer-term safety of MIS for AIS needs to be documented with a larger cohort and compared with the standard posterior approach. Cite this article: Bone Joint J 2020;102-B(4):506–512.

State of the art advances in minimally invasive surgery for adult spinal deformity

2020 ◽  
Vol 8 (6) ◽  
pp. 1143-1158
Author(s):  
Ibrahim Hussain ◽  
Kai-Ming Fu ◽  
Juan S. Uribe ◽  
Dean Chou ◽  
Praveen V. Mummaneni
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Spinal Deformity ◽  
State Of The Art ◽  
Adult Spinal Deformity

Home Versus Rehabilitation: Factors that Influence Disposition After Minimally Invasive Surgery in Adult Spinal Deformity Surgery

2018 ◽  
Vol 118 ◽  
pp. e610-e615 ◽  
Author(s):  
Robert K. Eastlack ◽  
Justin B. Ledesma ◽  
Stacie Tran ◽  
Amrit Khalsa ◽  
Paul Park ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Spinal Deformity Surgery

Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes

2010 ◽  
Vol 28 (3) ◽  
pp. E9 ◽  
Author(s):  
Michael Y. Wang ◽  
Praveen V. Mummaneni
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Interbody Fusion ◽  
Complication Rates ◽  
Surgical Morbidity ◽  
Minimally Invasive Surgical ◽  
Csf Leakage ◽  
The Mean

Object Adult degenerative scoliosis can be a cause of intractable pain, decreased mobility, and reduced quality of life. Surgical correction of this problem frequently leads to substantial clinical improvement, but advanced age, medical comorbidities, osteoporosis, and the rigidity of the spine result in high surgical complication rates. Minimally invasive surgery is being applied to this patient population in an effort to reduce the high complication rates associated with adult deformity surgery. Methods A retrospective study of 23 patients was undertaken to assess the clinical and radiographic results with minimally invasive surgery for adult thoracolumbar deformity surgery. All patients underwent a lateral interbody fusion followed by posterior percutaneous screw fixation and possible minimally invasive surgical transforaminal lumbar interbody fusion if fusion near the lumbosacral junction was necessary. A mean of 3.7 intersegmental levels were treated (range 2–7 levels). The mean follow-up was 13.4 months. Results The mean preoperative Cobb angle was 31.4°, and it was corrected to 11.5° at follow-up. The mean blood loss was 477 ml, and the operative time was 401 minutes. The mean visual analog scale score improvement for axial pain was 3.96. Clear evidence of fusion was seen on radiographs at 84 of 86 treated levels, with no interbody pseudarthroses. Complications included 2 returns to the operating room, one for CSF leakage and the other for hardware pullout. There were no wound infections, pneumonia, deep venous thrombosis, or new neurological deficits. However, of all patients, 30.4% experienced new thigh numbness, dysesthesias, pain, or weakness, and in one patient these new symptoms were persistent. Conclusions The minimally invasive surgical treatment of adult deformities is a promising method for reducing surgical morbidity. Numerous challenges exist, as the surgical technique does not yet allow for all correction maneuvers used in open surgery. However, as the techniques are advanced, the applicability of minimally invasive surgery for this population will likely be expanded and will afford the opportunity for reduced complications.

scholarly journals Is There a Patient Profile That Characterizes a Patient With Adult Spinal Deformity as a Candidate for Minimally Invasive Surgery?

2017 ◽  
Vol 7 (7) ◽  
pp. 703-708 ◽  
Author(s):  
Robert K. Eastlack ◽  
Gregory M. Mundis ◽  
Michael Wang ◽  
Praveen V. Mummaneni ◽  
Juan Uribe ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Patient Profile

scholarly journals The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer: A single center experience

2010 ◽  
Vol 57 (3) ◽  
pp. 29-35 ◽  
Author(s):  
I. Popescu ◽  
C. Vasilescu ◽  
V. Tomulescu ◽  
S. Vasile ◽  
O. Sgarbura
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive Surgery ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Metastatic Lymph Node ◽  
Robotic Approach ◽  
Invasive Approach ◽  
Significant Difference

Background: Robotic approach for rectal cancer competes with laparoscopy in centers dedicated to minimally invasive surgery (MIS) due to the technologic advantage. This is a report of our experience with MIS for rectal cancer. Methods: A series of 84 consecutive patients with laparoscopic resection (between 1995-2010) and 38 consecutive patients with robotic resection (between 2008-2010) for primary rectal cancer were analyzed. Hartmann's procedures were excluded. Clinical and pathologic outcomes were reviewed retrospectively. Results: In the laparoscopic group (LG), 50 anterior rectal resections (ARR), 34 abdominal perineal resections (APR) were performed while in the robotic group(RG) there were 30 ARR and 8 APR. The median operative time was 182 min (140-220 min) in LG and 208 min (180- 300 min) in RG (p=0.0002). No statistically significant difference was noticed between the groups in terms of conversion, morbidity, anastomotic leak and postoperative stay rates. Margin clearance was obtained in all patients and the median number of removed lymph nodes was similar: 11.37 in RG vs 11.07 in the LG (p=0.65) with a higher rate of metastatic lymph node involvement in laparoscopy (p=0.0012). Blood loss was higher in LG (150 ml vs. 100 ml; p=0.0001). There were 5 (5.9%) local recurrences in the LG at a median follow- up of 27.5 months and 2 (5.2%) in the RG at a median follow-up of 13 months (p=0.43). Conclusions: Minimally invasive surgery for rectal cancer proved to be safe and efficient with similar results in the two groups. Technological advances of robotic approach compared to laparoscopy allowed better ergonomics, more refined dissection, easier preserving of hypogastric nerves and less blood loss. Long term outcomes are to be assessed in prospective randomized studies.

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