Background: Ultrasonic bone-cutting devices (UBC) are new cutting tools and have low frequency ultrasonic blade. There is limited data on the safety and effectiveness of using ultrasonic bone-cutting devices in the treatment of adult spinal deformities (ASD). Objectives: This Retrospective review of prospectively collected data was designed to determine if the use of an ultrasonic bonecutting device is safe in the adult spinal deformity population and to compare its effectiveness in blood loss reduction by using a comparison group from a prospective multicenter database of adult spinal deformity patients. Methods: Nineteen consecutive surgical ASD cases in which the UBC was used were compared with 19 propensity-matched cases from a prospective ASD database in which conventional bone cutting instruments were used. The two groups were matched based on age, ASA, and number of levels fused posteriorly. The need for blood transfusion, volume of blood transfusion if required, estimated blood loss (EBL), and total operating time were compared between the two groups. Data were analyzed using non-parametric Mann-Whitney U test and Spearman's Correlation test (P < 0.05). Results: There was no statistically significant difference in any measured parameter between the two groups. While the EBL difference between the two groups (925 mL in the study group vs. 1628 mL in the control group) was not statistically significant (P = 0.142), the 703 mL difference is clinically relevant. In addition, no complications directly related to the use of the UBC were reported. Conclusions: The use of an ultrasonic bone-cutting device was shown to be safe and effective in the surgical treatment of ASD. It resulted in a 43% reduction in EBL, which was clinically relevant and statistically non-significant, without the addition of any complications. We did not identify statistical differences in transfusion rates, EBL, or operative time, which may be due to our small sample size.
Data Collection and AnalysisDemographic information was collected at baseline. Healthrelated quality-of-life outcomes, including the Oswestry Disability Index (ODI), back and leg pain numerical rating scale, and Scoliosis Research Society Patient Questionnaire (SRS-22r) were collected at all time points (baseline, six weeks, one year, and two years). Patient satisfaction was analyzed using the SRS-22r patient satisfaction domain. Radiographic parameters included sagittal vertical axis (SVA), pelvic tilt (PT), Pelvic Incidence (PI), Lumbar Lordosis (LL), and pelvic incidence minus lumbar lordosis mismatch (PI-LL). Total levels instrumented, operative time (minutes between incision and closing), length of hospital stay (days), and presence of threecolumn osteotomies were also assessed.Patient surgical date, complications, reoperation dates, and health-related quality-of-life outcomes were collected. Reoperation
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.
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