Adolescent Idiopathic Scoliosis: Is the Feasible Option of Minimally Invasive Surgery using Posterior Approach?

Abstract

The purpose of this systematic review and meta-analysis is to perform a systematic review and meta-analysis of previous studies on minimally invasive scoliosis surgery (MISS) in adolescents with idiopathic scoliosis (AIS). Some data on MISS in AIS compared with conventional open scoliosis surgery (COSS) are conflicting. A systematic literature search was conducted in Medline, Embase, and Cochrane Library, including studies reporting outcomes for MISS in AIS. The meta-analysis compared the operative, radiological, and clinical outcomes and complications between MISS and COSS in patients with AIS. Of the 208 records identified, 15 nonrandomized studies with 1,369 patients (reviews and case reports are excluded) were included in this systematic review and meta-analysis. The mean scale was 6.1, and eight of the 15 included studies showed satisfactory quality using the Newcastle-Ottawa scale. For operative outcomes, MISS had significant benefits in terms of estimated blood loss (standard mean difference [SMD], -1.87; 95% confidence interval [CI], -2.94 to -0.91) and hospitalization days (SMD, -2.99; 95% CI, -4.45 to -1.53) compared with COSS. However, COSS showed significantly favorable outcomes for operative times (SMD, 1.71; 95% CI, 0.92–2.51). No significant differences were observed in radiological outcomes, including Cobb’s angle of the main curve and thoracic kyphosis. For clinical outcomes, MISS showed significant benefits on the visual analog scale score (SMD, -0.91; 95% CI, -1.36 to -0.47). The overall complication rates of MISS were similar to those of COSS (SMD, 0.96; 95% CI, 0.61–1.52). MISS using the posterior approach provides equivalent radiological and clinical outcomes and complication rates compared with COSS. Considering the lower estimated blood loss, shorter hospitalization days, and longer operative times in MISS, COSS is still the mainstay of surgical treatment in AIS; however, MISS using the posterior approach is also one of the surgical options of choice in the case of moderate AIS.

Hidden Blood Loss and Its Risk Factors for Oblique Lumbar Interbody Fusion

“…Substantial blood loss during spinal surgery can lead to various complications, including postoperative anemia, prolonged hospital stays, and increased morbidity and mortality [ 1 , 2 , 3 , 4 , 5 ]. Surgical management of degenerative spine disease using interbody fusion has increased significantly, but the traditional posterior approach is associated with a large amount of blood loss and requires massive blood transfusion [ 1 , 6 ].…”

Association of Functional Gastrointestinal Disorders with Adolescent Idiopathic Scoliosis

“…Various surgical methods exist, but posterior spinal fusion surgery using pedicle screws is commonly and widely performed. Recently, minimally invasive surgical techniques have also gained attention [5].…”