Prospective multicenter study of minimally invasive surgery for the treatment of adult spinal deformity

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  • 1 San Diego Spine Foundation, Scripps Clinic, La Jolla, California;
  • | 2 Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona;
  • | 3 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;
  • | 4 Department of Neurosurgery, Weill Cornell Medical College, New York, New York;
  • | 5 Department of Neurosurgery, University of Miami, Coral Gables, Florida;
  • | 6 Department of Neurosurgery, Duke University, Durham, North Carolina;
  • | 7 Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
  • | 8 Spine Institute Foundation, Shreveport, Louisiana;
  • | 9 Anand Spine Group, Los Angeles, California;
  • | 10 Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;
  • | 11 Department of Neurosurgery, University of California, San Francisco, California; and
  • | 12 Department of Orthopedics, Hospital of Special Surgery, New York, New York
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OBJECTIVE

Traditional surgery for adult spinal deformity (ASD) is effective but may result in exposure-related morbidity. Minimally invasive surgery (MIS) can potentially minimize this morbidity; however, high-level evidence is lacking. This study presents the first prospective multicenter investigation of MIS approaches for ASD.

METHODS

A prospective multicenter study was conducted. Inclusion criteria were age ≥ 18 years, with at least one of the following radiographic criteria: coronal Cobb (CC) angle ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic tilt (PT) > 25°, and thoracic kyphosis > 60°. Additional inclusion criteria were circumferential MIS, including interbody fusion (transforaminal lumbar interbody fusion [TLIF], lateral lumbar interbody fusion [LLIF], or anterior lumbar interbody fusion [ALIF]) with percutaneous posterior fixation on a minimum of 4 intervertebral levels. Radiographic and clinical outcomes (visual analog scale [VAS], Oswestry Disability Index [ODI], and Scoliosis Research Society–22 [SRS-22]) were collected preoperatively and at 12 months postoperatively; preoperative and postoperative values were compared using paired Student t-tests.

RESULTS

Seventy-five patients with a minimum 1-year follow-up were identified (75 of 111; 67.6%). The mean ± SD age was 68.8 ± 9.0 years, and 48 patients (64%) were female. Patients underwent a mean of 6.7 ± 2.9 levels of fusion with LLIF (85%), ALIF (55%), and TLIF (9%); the mean estimated blood loss was 547.6 ± 567.2 mL, and the mean length of stay was 7.0 ± 3.7 days. Significant improvements were observed in ODI (−19 ± 12.9, p < 0.001), SRS-22 (0.8 ± 0.66, p < 0.001), VAS back (−4.3 ± 2.8, p < 0.001), and VAS leg (−3.0 ± 3.2, p < 0.001) scores. Significant decreases in SVA (−26.4 ± 53.6 mm; p < 0.001), pelvic incidence–lumbar lordosis (−11.3° ± 14.9°, p < 0.001), and CC angle (−12.1° ± 11.8°, p < 0.001) were also observed. Complications occurred in 39 patients (52%); 11 patients (15%) experienced major complications, and 16 patients (21%) required reoperation.

CONCLUSIONS

MIS approaches for ASD resulted in meaningful symptomatic improvement. The complication rates were similar to historic norms, with a fairly high reoperation rate at 1 year. Longer follow-up will be necessary to evaluate the durability of this approach in the treatment of ASD.

ABBREVIATIONS

ACR = anterior column realignment; ALIF = anterior lumbar interbody fusion; ASD = adult spinal deformity; CC = coronal Cobb; LLIF = lateral lumbar interbody fusion; MCID = minimal clinically important difference; MIS = minimally invasive surgery; ODI = Oswestry Disability Index; PT = pelvic tilt; SRS-22r = Scoliosis Research Society–22 revised; SVA = sagittal vertical axis; TLIF = transforaminal lumbar interbody fusion; VAS = visual analog scale.

Supplementary Materials

    • Figure S1 (PDF 881 KB)

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