Role of minimally invasive surgery for adult spinal deformity in preventing complications

Yen, Chun-Po; Mosley, Yusef I.; Uribe, Juan S.

doi:10.1007/s12178-016-9355-6

Cited by 27 publications

(13 citation statements)

References 42 publications

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“…The recent concept of cMIS is a combination of MIS lumbar interbody fusion and percutaneous fixation without osteotomy [3,[5][6][7][8]. Previously, cMIS was not indicated for sagittal correction of ASD [7,14,25,26].…”

Section: Discussionmentioning

confidence: 99%

“…Minimally invasive surgery (MIS) can be an alternative surgical treatment with comparable surgical outcomes and lower complication rates [3][4][5][6][7][8]. Among various MIS techniques, transforaminal lumbar interbody fusion (TLIF), extreme lateral interbody fusion, or oblique lateral interbody fusion (OLIF) combined with percutaneous posterior spine fixation (PPSF) without any posterior osteotomy are important techniques for minimally invasive deformity [3][4][5][6][8][9][10]. Deformity correction using MIS techniques without any conventional open surgery is referred to as circumferential MIS (cMIS) [5,11,12].…”

Section: Introductionmentioning

confidence: 99%

“…Compared with conventional deformity surgery, cMIS is known to be effective for coronal but not for sagittal correction [5-7, 13, 14]. cMIS has been advanced continuously in sagittal correction of ASD [5,6,13]. Despite recent advancements, cMIS remains limited by the insufficient correction of marked sagittal deformity [5,15,16].…”

Section: Introductionmentioning

confidence: 99%

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Correction of marked sagittal deformity with circumferential minimally invasive surgery using oblique lateral interbody fusion in adult spinal deformity

Park

Kim

et al. 2020

J Orthop Surg Res

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Background: Spinal surgery performed entirely with minimally invasive surgery is referred to as circumferential MIS (cMIS). However, cMIS still has a limited sagittal correction capability for adult spinal deformity (ASD) with a marked sagittal deformity. We investigated the effectiveness of cMIS using oblique lateral interbody fusion (OLIF) and percutaneous posterior spine fixation in correcting marked sagittal deformity. Methods: This study retrospectively evaluated 23 patients with ASD with marked sagittal deformity who underwent cMIS using OLIF without osteotomy and were followed-up for at least 24 months (whole group). The whole group was divided into the following two groups according to the type of interbody fusion at L5-S1: the OLIF51 group (n = 13) underwent OLIF at L1-L5 and L5-S1 and the TLIF51 group (n = 10) underwent OLIF at L1-L5 and transforaminal lumbar interbody fusion (TLIF) at L5-S1. Results: Sagittal vertebral axis (SVA; 125.7 vs. 29.5 mm, p < 0.001), lumbar lordosis (LL; 18.2°vs. 51.7°, p < 0.001), and pelvic incidence-LL mismatch (PI-LL, 35.5°vs. 5.3°) significantly improved postoperatively in the whole group. The OLIF51 group showed significantly higher postoperative LL than the TLIF51 group (55.5°vs. 46.9°, p < 0.001). OLIF yielded a significantly greater disc angle at L5-S1 than did TLIF (18.4°vs. 6.9°, p < 0.001). Proximal junctional kyphosis occurred significantly earlier in the OLIF51 group than in the TLIF51 group (8.6 vs. 26.3 months, p < 0.001). Conclusion: Successful sagittal correction in ASD patients with marked sagittal deformity was achieved with cMIS using OLIF. OLIF at L5-S1 showed a synergistic effect in sagittal deformity correction by cMIS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Correction of marked sagittal deformity with circumferential minimally invasive surgery using oblique lateral interbody fusion in adult spinal deformity

Park

Kim

et al. 2020

J Orthop Surg Res

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“…Compared with open surgical techniques, MIS for degenerative spinal conditions has demonstrated decreased blood loss, length of stay, and risk of infection, while also preserving paraspinal musculature. 23,40 However, early application of MIS for the treatment of spinal deformi- ties was limited due to inadequate restoration of sagittal spinopelvic imbalance and PI-LL mismatch. 8,14 Initial attempts to apply MIS strategies only targeted patients with mild spinal deformities, including low pelvic tilt, low PI, or purely coronal curve corrections.…”

Section: Discussionmentioning

confidence: 99%

The comprehensive anatomical spinal osteotomy and anterior column realignment classification

Uribe

Schwab

Mundis

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVESpinal osteotomies and anterior column realignment (ACR) are procedures that allow preservation or restoration of spine lordosis. Variations of these techniques enable different degrees of segmental, regional, and global sagittal realignment. The authors propose a comprehensive anatomical classification system for ACR and its variants based on the level of technical complexity and invasiveness. This serves as a common language and platform to standardize clinical and radiographic outcomes for the utilization of ACR.METHODSThe proposed classification is based on 6 anatomical grades of ACR, including anterior longitudinal ligament (ALL) release, with varying degrees of posterior column release or osteotomies. Additionally, a surgical approach (anterior, lateral, or posterior) was added. Reliability of the classification was evaluated by an analysis of 16 clinical cases, rated twice by 14 different spine surgeons, and calculation of Fleiss kappa coefficients.RESULTSThe 6 grades of ACR are as follows: grade A, ALL release with hyperlordotic cage, intact posterior elements; grade 1 (ACR + Schwab grade 1), additional resection of the inferior facet and joint capsule; grade 2 (ACR + Schwab grade 2), additional resection of both superior and inferior facets, interspinous ligament, ligamentum flavum, lamina, and spinous process; grade 3 (ACR + Schwab grade 3), additional adjacent-level 3-column osteotomy including pedicle subtraction osteotomy; grade 4 (ACR + Schwab grade 4), 2-level distal 3-column osteotomy including pedicle subtraction osteotomy and disc space resection; and grade 5 (ACR + Schwab grade 5), complete or partial removal of a vertebral body and both adjacent discs with or without posterior element resection. Intraobserver and interobserver reliability were 97% and 98%, respectively, across the 14-reviewer cohort.CONCLUSIONSThe proposed anatomical realignment classification provides a consistent description of the various posterior and anterior column release/osteotomies. This reliability study confirmed that the classification is consistent and reproducible across a diverse group of spine surgeons.

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“…2,10,11 Given these conditions, substantial enthusiasm has been demonstrated for minimally invasive surgery (MIS) options. 5,7,18,22 Various technical methods have been developed to achieve these ends, including 1) leveraging alternate access routes, such as with anterior or lateral access surgery; 2) using osteobiologic adjuvants to improve the rates of successful arthrodesis; and 3) using percutaneous fixation methods to obviate the need for extensive muscle dissection.…”

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confidence: 99%

Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers

Wang

Tran

Brusko

et al. 2019

Journal of Neurosurgery: Spine

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OBJECTIVEThe past decade has seen major advances in techniques for treating more complex spinal disorders using minimally invasive surgery (MIS). While appealing from the standpoint of patient perioperative outcomes, a major impediment to adoption has been the significant learning curve in utilizing MIS techniques.METHODSData were retrospectively analyzed from a multicenter series of adult spinal deformity surgeries treated at eight tertiary spine care centers in the period from 2008 to 2015. All patients had undergone a less invasive or hybrid approach for a deformity correction satisfying the following inclusion criteria at baseline: coronal Cobb angle ≥ 20°, sagittal vertical axis (SVA) > 5 cm, or pelvic tilt > 20°. Analyzed data included baseline demographic details, severity of deformity, surgical metrics, clinical outcomes (numeric rating scale [NRS] score and Oswestry Disability Index [ODI]), radiographic outcomes, and complications. A minimum follow-up of 2 years was required for study inclusion.RESULTSAcross the 8-year study period, among 222 patients, there was a trend toward treating increasingly morbid patients, with the mean age increasing from 50.7 to 62.4 years (p = 0.013) and the BMI increasing from 25.5 to 31.4 kg/m2 (p = 0.12). There was no statistical difference in the severity of coronal and sagittal deformity treated over the study period. With regard to radiographic changes following surgery, there was an increasing emphasis on sagittal correction and, conversely, less coronal correction. There was no statistically significant difference in clinical outcomes over the 8-year period, and meaningful improvements were seen in all years (ODI range of improvement: 15.0–26.9). Neither were there statistically significant differences in major complications; however, minor complications were seen less often as the surgeons gained experience (p = 0.064). Operative time was decreased on average by 47% over the 8-year period.Trends in surgical practice were seen as well. Total fusion construct length was unchanged until the last year when there was a marked decrease in conjunction with a decrease in interbody levels treated (p = 0.004) while obtaining a higher degree of sagittal correction, suggesting more selective but powerful interbody reduction methods as reflected by an increase in the lateral and anterior column resection techniques being utilized.CONCLUSIONSThe use of minimally invasive methods for adult spinal deformity surgery has evolved over the past decade. Experienced surgeons are treating older and more morbid patients with similar outcomes. A reliance on selective, more powerful interbody approaches is increasing as well.

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Role of minimally invasive surgery for adult spinal deformity in preventing complications

Cited by 27 publications

References 42 publications

Correction of marked sagittal deformity with circumferential minimally invasive surgery using oblique lateral interbody fusion in adult spinal deformity

Correction of marked sagittal deformity with circumferential minimally invasive surgery using oblique lateral interbody fusion in adult spinal deformity

The comprehensive anatomical spinal osteotomy and anterior column realignment classification

Less invasive spinal deformity surgery: the impact of the learning curve at tertiary spine care centers

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