Two- and three-year outcomes of minimally invasive and hybrid correction of adult spinal deformity

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  • 1 Department of Neurological Surgery, University of California, San Francisco, California;
  • | 2 Scripps Clinic, La Jolla, California;
  • | 3 Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois;
  • | 4 Department of Neurosurgery, Duke University, Durham, North Carolina;
  • | 5 Department of Neurosurgery, Weill Cornell Medical Center, New York, New York;
  • | 6 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;
  • | 7 Department of Neurosurgery, University of Miami, Florida;
  • | 8 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
  • | 9 Spine Institute of Louisiana, Shreveport, Louisiana;
  • | 10 Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California;
  • | 11 Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; and
  • | 12 Denver International Spine Center, Presbyterian St. Luke’s/Rocky Mountain Hospital for Children, Denver, Colorado
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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.

ABBREVIATIONS

ALIF = anterior lumbar interbody fusion; AP = anteroposterior; ASD = adult spinal deformity; CC = coronal Cobb angle; cMIS = circumferential MIS; DJK = distal junctional kyphosis; LIV = lower instrumented vertebrae; MIS = minimally invasive surgery; ODI = Oswestry Disability Index; PI-LL = pelvic incidence–lumbar lordosis mismatch; PJK = proximal junctional kyphosis; PROM = patient-reported outcome measure; PT = pelvic tilt; SS = sacral slope; SVA = sagittal vertical axis; UIV = upper instrumented vertebrae; VAS = visual analog scale.

Spine - 1 year subscription bundle (Individuals Only)

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JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

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