Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis

Abstract

Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

Minimally Invasive Surgery for Neuromuscular Scoliosis

“…2 Such approaches are rarely reported in neuromuscular scoliosis patients. 3 Our aim is to develop a minimally invasive approach for insertion of a strong and stable construct capable of further adjustments and avoidance of final fusion.…”

Minimally Invasive Scoliosis Surgery Is a Feasible Option for Management of Idiopathic Scoliosis and Has Equivalent Outcomes to Open Surgery: A Meta-Analysis

“…Traditional open techniques are considered the gold standard for the surgical management of scoliosis, though as minimally invasive spine surgery is becoming more widely practiced it is being increasingly applied to pediatric deformity correction. [15][16][17][18][19][20] This meta-analysis was conducted to evaluate the differences in outcomes between open and MIS deformity correction and found that MISS is associated with less blood loss but longer operative times compared to traditional open fusion for AIS, while demonstrating similar outcomes in terms of curve correction, postoperative pain, LOS, and complications/reoperations. MISS is emerging as a feasible tool in deformity correction, particularly in adult populations.…”

Paraspinal muscle approach for neuromuscular scoliosis: A comparative study evaluating deformity correction and perioperative morbidity in 91 patients with minimum 2-year follow-up

“…8 , 14 A modification of it was described to adapt for NMS cases which need longer instrumentations and usually present with more rigid curves. 11 We used a single midline skin incision extending from upper to lower instrumented vertebra and following the spinous processes. No fluoroscopy was used to determine the length and localization of it.…”

“…Only one retrospective comparative series including 24 patients and one surgical technique paper including two case reports have been published up to date. 11 , 12 Both publications reported a lower EBL in comparison to the posterior midline approach and the surgical technique paper showed additionally a shorter intensive care unit (ICU) and hospital LOS.…”