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

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  • 1 Department of Neurosurgery, University of California, San Francisco, San Francisco, California;
  • | 2 Department of Orthopedic Surgery, New York University, New York, New York;
  • | 3 Department of Neurosurgery, University of California, Irvine, Orange, California;
  • | 4 Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California;
  • | 5 Department of Orthopedic Surgery, Scripps Health, La Jolla, California;
  • | 6 Department of Neurosurgery, Weill Cornell Medical College, New York, New York;
  • | 7 Department of Neurosurgery, Rush University, Chicago, Illinois;
  • | 8 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;
  • | 9 Department of Neurosurgery, Duke University, Durham, North Carolina;
  • | 10 Department of Orthopedic Surgery, Cedars-Sinai, Los Angeles, California;
  • | 11 Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona;
  • | 12 Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania;
  • | 13 Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado;
  • | 14 Department of Neurosurgery, Duke University, Durham, North Carolina;
  • | 15 Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York;
  • | 16 Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;
  • | 17 Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland; and
  • | 18 Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
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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.

ABBREVIATIONS

ASD = adult spinal deformity; cMIS = circumferential minimally invasive spine surgery; ISSG = International Spine Study Group; MCID = minimal clinically important difference; ODI = Oswestry Disability Index; PI = pelvic incidence; PI-LL = pelvic incidence minus lumbar lordosis; PT = pelvic tilt; SRS = Scoliosis Research Society; SVA = sagittal vertical axis; TLIF = transforaminal lumbar interbody fusion; T1PA = T1 pelvic angle.

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