Minimal invasive posterior correction of Lenke 5C idiopathic scoliosis: comparative analysis of minimal invasive vs. open surgery

A 10-year perspective on the question of whether surgeries for adolescent idiopathic scoliosis are "one and done"?

PURPOSE

Posterior scoliosis fusion (PSF) for adolescent idiopathic scoliosis (AIS) is considered a highly successful surgery with excellent outcomes. However, especially as many patients "graduate" from their pediatric surgeons, there is the need to quantify the long-term outcomes of such surgeries.

METHODS

The 2010-2022 Pearldiver M161 dataset was queried for those who were 10 to 18 years old with AIS undergoing PSF with at least 10 years follow-up. Patient characteristics were abstracted. Reoperations were identified based on coding for any subsequent thoracic/lumbar surgery/revision. The 10-year reoperation rate and reasons for reoperation were determined, and multivariate regression was performed to determine risk factors.

RESULTS

In total, 3,373 AIS PSF patients were identified. Of the study cohort, 324 (9.6%) underwent reoperation within 10-years with an interquartile range for timing of surgery of 81-658 days, of which 29.6% were done for infection. Reoperations were done within the first three months for 152 (46.9% of reoperations), three months to 2 years for 97 (29.9%), and 2 years to 10 years for 74 (22.8%). Based on multivariate regression, need for reoperation was associated with male sex (OR: 1.70), asthma (OR: 1.36) and greater than thirteen segments of instrumentation (OR: 1.48) (p < 0.05 for each) but not age, other comorbidities, or insurance.

CONCLUSIONS

The current study of a large national AIS PSF population found 9.6% to undergo reoperation in the 10 years following their index operation. Although specifics about the curve pattern could not be determined, the reoperation incidence and correlation with specific risk factors are notable and important for patient counselling.

Minimally invasive surgery versus standard posterior approach in the treatment of adolescent idiopathic scoliosis: a 2-year follow-up retrospective study

PURPOSE

This is a monocentric retrospective controlled study that compares the safety and efficacy of posterior minimally invasive surgery (MISS) to standard posterior spinal fusion (PSF) surgery in adolescent idiopathic scoliosis (AIS).

METHODS

We retrospectively collected 111 patients with Lenke type 1-6 AIS who were treated with MIS (n = 47) or PSF (n = 64) between February 2019 and January 2021 with a 2-year clinical and radiological follow-up. MIS technique was applied via two midline noncontiguous skin incisions ranging from 3 to 7 cm in length, so we obtained the arthrodesis only in the exposed tract, passing the rods below the fascia, avoiding the complete muscular sparing. Values of Cobb angles degrees were collected to study the correction rate of the structural major curve. Postoperative AP direct radiography and preoperative AP direct radiography were compared with the last follow-up examination. Operative time, preoperative hemoglobin (Hb) and second postoperative day Hb, full length of hospitalization, time to achieve verticalization and time to remove the drainage were recorded. NRS medium score was assessed immediately after surgery and during the whole postoperative rehabilitation treatment to estimate pain reduction. Complications were collected postoperatively and throughout the whole follow-up period.

RESULTS

There was no significant difference between the two groups in terms of radiographic and clinical features. The correction rates of the structural curve resulted to be not significantly different between MISS and PSF (64.6 ± 11.7 vs 60.9 ± 13.2, p = 0.1292) as well as for the correction rate of the secondary curve between the two compared techniques (59.1 ± 13.2 vs 59.2 ± 12.4, p = 0.9865). The two groups had comparable operative time (210 min vs 215 min). The MIS group had a significantly lower reduction of postoperative Hb in comparison with PSF group (2.8 ± 1.3 mg/dl vs 4.3 ± 1.5 mg/dl, p < 0.0001). The postoperative NRS score was lower in MIS group (1.9 ± 0.8 vs 3.3 ± 1.3). PSF group was observed to have a significantly longer period of hospitalization than MIS (5.2 ± 1.4 days vs 6.3 ± 2.9 days, p = 0.206). Complications were more frequent in PSF group rather than in MFS group.

CONCLUSIONS

MISS is a safe and capable alternative to PSF for AIS patients with curves < 70°, with analogue capacity of scoliosis correction and same operative time and with advantages in blood loss, length of stay and postoperative pain.

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

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.

Minimally Invasive Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review

Background: Minimally invasive surgical (MIS) techniques have gained popularity as a safe and effective alternative to open surgery for degenerative, traumatic, and metastatic spinal pathologies. In adolescent idiopathic scoliosis, MIS techniques comprise anterior thoracoscopic surgery (ATS), posterior minimally invasive surgery (PMIS), and vertebral body tethering (VBT). In the current systematic review, the authors collected and analyzed data from the available literature on MIS techniques in AIS. Methods: The articles were shortlisted after a thorough electronic and manual database search through PubMed, EMBASE, and Google Scholar. Results: The authors included 43 studies for the review; 14 described the outcomes with ATS, 13 with PMIS, and 16 with VBT. Conclusions: While the efficacy of the ATS approach is well-established in terms of comparable coronal and sagittal correction to posterior spinal fusion, the current use of ATS for instrumented fusion has become less popular due to a steep learning curve, high pulmonary and vascular complication rates, implant failures, and increased non-union rates. PMIS is an effective alternative to the standard open posterior spinal fusion, with a steep learning curve and longer surgical time being potential disadvantages. The current evidence, albeit limited, suggests that VBT is an attractive procedure that merits consideration in terms of radiological correction and clinical outcomes, but it has a high complication and re-operation rate, while the most appropriate indications and long-term outcomes of this technique remain unclear.

Single Long-Incision Minimally Invasive Surgery

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

The objective of this study is to determine differences in outcomes in patients with adolescent idiopathic scoliosis undergoing spinal deformity correction surgery using a posterior spinal fusion (PSF) approach versus single and triple-incision minimally invasive surgery (MIS).

SUMMARY OF BACKGROUND DATA

MIS increased in popularity as surgeons' focus moved towards soft tissue preservation, but it carries technical demands and increased surgical time compared with PSF.

PATIENTS AND METHODS

Surgeries performed from 2016 to 2020 were included. Cohorts were formed based on surgical approach: PSF versus single long-incision MIS (SLIM) versus traditional MIS [3-incision MIS (3MIS)]. There were a total of 7 subanalyses. Demographic, radiographic, and perioperative data were collected for the 3 groups. Kruskal-Wallis and χ 2 tests were used for continuous and categorical variables, respectively.

RESULTS

Five hundred thirty-two patients met our inclusion criteria, 294 PSF, 179 3MIS, and 59 SLIM.Estimated blood loss (mL) ( P < 0.00001) and length of stay (LOS) ( P < 0.00001) was significantly higher in PSF than in SLIM and 3MIS. Surgical time was significantly higher in 3MIS than in PSF and SLIM ( P = 0.0012).Patients who underwent PSF had significantly lower postoperative T5 to T12 kyphosis ( P < 0.00001) and percentage kyphosis change ( P < 0.00001). Morphine equivalence was significantly higher in the PSF group during total hospital stay ( P = 0.0042).Patients who underwent SLIM and 3MIS were more likely to return to noncontact ( P = 0.0096) and contact sports ( P = 0.0095) within 6 months and reported lower pain scores ( P < 0.001) at 6 months postoperation.

CONCLUSION

SLIM has a similar operative time to PSF and is technically similar to PSF while maintaining the surgical and postoperative outcome advantages of 3MIS.

Minimally Invasive Surgery for Posterior Spinal Instrumentation and Fusion in Adolescent Idiopathic Scoliosis: Current Status and Future Application

The posterior minimally invasive spine surgery (MISS) approach-or the paraspinal muscle approach-for posterior spinal fusion and segmental instrumentation in adolescent idiopathic scoliosis (AIS) was first reported in 2011. It is less invasive than the traditionally used open posterior midline approach, which is associated with significant morbidity, including denervation of the paraspinal muscles, significant blood loss, and a large midline skin incision. The literature suggests that the MISS approach, though technically challenging and with a longer operative time, provides similar levels of deformity correction, lower intraoperative blood loss, shorter hospital stays, better pain outcomes, and a faster return to sports than the open posterior midline approach. Correction maintenance and fusion rates also seem to be equivalent for both approaches. This narrative review presents the results of relevant publications reporting on spinal segmental instrumentation using pedicle screws and posterior spinal fusion as part of an MISS approach. It then compares them with the results of the traditional open posterior midline approach for treating AIS. It specifically examines perioperative morbidity and radiological and clinical outcomes with a minimal follow-up length of 2 years (range 2-9 years).

Less correction with minimally invasive surgery for adolescent idiopathic scoliosis compared to open surgical correction

Purpose

In this study, we investigated the relationship between the results of thoracic curve correction using minimally invasive surgeries in 35 patients and open surgical correction in 47 patients with adolescent idiopathic scoliosis.

Methods

The correlations between the Cobb's angle of the primary and postoperative curves, angle of thoracic kyphosis and lumbar lordosis, correction percentage, derotation values, estimated blood loss, duration of surgery, and period of hospitalization after surgery were assessed by calculating the mean and standard deviation. Calculation and comparison were performed using Pearson correlation.

Results

The Cobb's angle correction ranged from 53.4° ± 11.8° to 6.7° ± 5.2° (p < 0.001) in the open surgical correction group and from 51.2° ± 11.4° to 11.7° ± 5.8° (p < 0.001) in the minimally invasive surgery group before and after surgery, respectively. The percentage of curvature correction was 88.2% ± 8.0% and 77.7% ± 10.7% (p < 0.001) in the open surgical correction and minimally invasive surgery groups, respectively. The estimated blood loss was higher in the open surgical correction group than in the minimally invasive surgery group (208.7 ± 113.4 vs 564.3 ± 242.7 mL). Axial rotation was changed from 29.1°± 7.5 to 17.1°± 6.8 (p < 0.001) in the open surgical correction group and from 28.9°± 7.8 to 19.4°± 6.4 (p < 0.001) in the minimally invasive surgery group. The duration of surgery was shorter in the open surgical correction group than in the minimally invasive surgery group (266.6 ± 64.3 vs 346.2 ± 70.5 min). A positive correlation between time of operation and Cobb's angle correction (in °) in open surgical correction (r = 0.37) and minimally invasive surgery (r = 0.43) was found.

Conclusion

The open surgical correction procedures were more effective than minimally invasive surgery in correcting the spinal curve. The increase in the duration of open surgical correction increases the estimated blood loss, but it also more significantly improves the correction of Cobb's angle.

Level of evidence

III.

Less correction with minimally invasive surgery for adolescent idiopathic scoliosis compared to open surgical correction

Purpose:

In this study, we investigated the relationship between the results of thoracic curve correction using minimally invasive surgeries in 35 patients and open surgical correction in 47 patients with adolescent idiopathic scoliosis.

Methods:

The correlations between the Cobb’s angle of the primary and postoperative curves, angle of thoracic kyphosis and lumbar lordosis, correction percentage, derotation values, estimated blood loss, duration of surgery, and period of hospitalization after surgery were assessed by calculating the mean and standard deviation. Calculation and comparison were performed using Pearson correlation.

Results:

The Cobb’s angle correction ranged from 53.4° ± 11.8° to 6.7° ± 5.2° ( p < 0.001) in the open surgical correction group and from 51.2° ± 11.4° to 11.7° ± 5.8° ( p < 0.001) in the minimally invasive surgery group before and after surgery, respectively. The percentage of curvature correction was 88.2% ± 8.0% and 77.7% ± 10.7% ( p < 0.001) in the open surgical correction and minimally invasive surgery groups, respectively. The estimated blood loss was higher in the open surgical correction group than in the minimally invasive surgery group (208.7 ± 113.4 vs 564.3 ± 242.7 mL). Axial rotation was changed from 29.1°± 7.5 to 17.1°± 6.8 ( p < 0.001) in the open surgical correction group and from 28.9°± 7.8 to 19.4°± 6.4 ( p < 0.001) in the minimally invasive surgery group. The duration of surgery was shorter in the open surgical correction group than in the minimally invasive surgery group (266.6 ± 64.3 vs 346.2 ± 70.5 min). A positive correlation between time of operation and Cobb’s angle correction (in °) in open surgical correction ( r = 0.37) and minimally invasive surgery ( r = 0.43) was found.

Conclusion:

The open surgical correction procedures were more effective than minimally invasive surgery in correcting the spinal curve. The increase in the duration of open surgical correction increases the estimated blood loss, but it also more significantly improves the correction of Cobb’s angle.

Level of evidence:

III.

Minimally invasive surgery using posterior-only Pedicle screw fixation in treatment of Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis

Minimally invasive surgery (MIS) techniques for posterior spine pedicle-screw fusion (PSF) may reduce the AIS surgery invasiveness, although they require a certain degree of patient selection based on the severity of the curve. The aim of this article is to systematically review the Literature to determine efficacy and safety of MIS-PSF in AIS correction, and to compare its outcomes with open-PSF. A systematic search of electronic databases from eligible articles was conducted. Only studies adopting MIS-PSF for AIS were included. Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed. P-value < 0.05 was considered significant. Thirteen studies for a total of 635 patients ungergoing MIS-PSF were included in this review. Pre-operative Cobb's angle ranged from 48.3°±4.2° to 59.8°±6.6°, coronal correction from 58.1% to 79.1%, average operative time ranged from 252 to 526.8 min, average estimated blood loss from 138.8 ± 50 to 1250 mL. Sixty-seven complications were recorded (9.9%), with 19 revisions (3.8%), resulting similar to those described in Literature using open-PSF. At meta-analysis, MIS-PSF (321 patients) compared to open-PSF (429 patients) showed lower coronal correction (although no statistically significant difference was found), estimated blood loss and length of hospital stay, but higher operative time. No differences in SRS-22, complications and revision rate were found. In conclusion, open-PSF shows a trend towards higher correction in the coronal plane and requires a shorter operative time when compared to MIS-PSF. It remains the gold standard for AIS correction, although MIS-PSF seems to be a viable and promising technique for selected patients. - KEYWORDS: minimally invasive surgery, minimally invasive techniques, adolescent idiopathic scoliosis, posterior spinal fusion, pedicle-screws-only instrumentation.

Posterior minimally invasive scoliosis surgery versus the standard posterior approach for the management of adolescent idiopathic scoliosis: an updated meta-analysis

Background

Surgical management of adolescent idiopathic scoliosis (AIS) can be performed using standard posterior spinal fusion (PSF) or with a posterior minimally invasive approach. Minimally invasive scoliosis surgery (MISS) has several theoretical advantages, such as less tissue dissection, less blood loss, and earlier recovery. However, the difference in safety and effectiveness between MISS and PSF still needs to be clarified. This updated meta-analysis aimed to compare the outcomes of MISS and standard PSF for the management of AIS.

Methods

A comprehensive literature search of PubMed, EMBASE, MEDLINE, and Cochrane Library without time restriction was performed to identify relevant studies. MISS and PSF were compared in terms of radiographic parameters, estimated blood loss (EBL), blood transfusion rate, operative time (ORT), length of hospital stay (LOS), overall Scoliosis Research Society-22 (SRS-22) score, postoperative pain, and complication rate.

Results

A total of seven studies comprising 767 patients (329 MISS and 438 PSF) with AIS were included. MISS and PSF yielded comparable deformity correction at the last follow-up. There were no significant differences in the overall SRS-22 scores or complication rates between the groups. Nevertheless, greater restoration of thoracic kyphosis (WMD, 2.98; 95% CI 0.58 to 5.37, P = 0.015), less EBL (WMD, −218.76; 95% CI −256.41 to −181.11, P < 0.001), a lower blood transfusion rate (RR, 0.31; 95% CI 0.20 to 0.48, P < 0.001), a shorter LOS (WMD, −1.48; 95% CI −2.48 to −0.48, P = 0.004), less postoperative pain (WMD, 0.57; 95% CI 0.16 to 0.98, P = 0.006), and a longer ORT (WMD, 84.85; 95% CI 33.30 to 136.40, P = 0.001) were observed in the MISS group.

Conclusion

Despite its inherent technical challenges, MISS is a feasible and effective alternative to standard PSF for AIS patients with moderate and flexible curves. MISS was associated with adequate deformity correction, better restoration of sagittal alignment, less EBL, fewer transfusions, shorter LOS, and better pain management compared to PSF. Further research is required to determine the detailed indications for the MISS procedure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-022-02954-4.

Minimally Invasive Versus Standard Surgery in Idiopathic Scoliosis Patients: A Comparative Study

STUDY DESIGN

Retrospective review of prospective case-control study.

OBJECTIVE

To compare minimally invasive scoliosis surgery (MIS) and posterior spinal fusion (PSF) in a large group of patients.

SUMMARY OF BACKGROUND DATA

MIS, has been shown to have benefits over standard PSF in adolescent idiopathic scoliosis (AIS).

METHODS

Radiographic, clinical, and operative review of a multi-institutional prospective database from 2013 to 2018. MIS patients with minimum 2-year XR follow up were compared with open PSF technique patients.

RESULTS

Four hundred eighty five patients were included; 192 MIS and 293 PSF. Preoperative Cobb (P = 0.231) and kyphosis were similar (P = 0.501). Cobb correction was comparable (P = 0.46), however percent improvement in thoracic kyphosis was significantly higher in MIS (P < 0.001). MIS had significantly lower blood loss (P < 0.001), transfusions (P < 0.001), fixation points (P < 0.001), opioid consumption (P = 0.001), and hospital stay (P < 0.001). Operative time was shorter (P = 0.001) and 30-day complications rate was similar (P = 0.81).

CONCLUSION

This is the largest study comparing the surgical outcomes of MIS and PSF. MIS patients benefit from increased kyphosis, fewer transfusion, lower opioid consumption, and shorter hospital stay with similar Cobb correction. Increased postoperative kyphosis is likely from muscle sparing dissection in MIS.Level of Evidence: 3.

Minimally Invasive Surgery versus Open Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis

Minimally invasive surgery (MIS) is being recommended over more invasive methods. MIS advantages are less time in the operating room, less blood loss, a shorter recovery time, and shorter length of stay. A systematic review and meta-analysis were performed using the literature from minimally invasive and open surgery for adolescent idiopathic scoliosis (AIS). We conducted this analysis to see whether MIS has advantages over traditional surgery. A systematic review was conducted using PubMed, Embase, and Scopus to find articles comparing minimally invasive and open surgery techniques for AIS patients. Data extraction and meta-analysis were completed. The primary data points collected were correction rate and functional outcomes, including perioperative and postoperative parameters. A total of six studies were included in the final analysis. The MIS group had 123 patients, and the open surgery group had 150 patients. The correction rate and functional outcomes favored the open surgery group with a mean difference of 4.60 (95% confidence interval [CI], 0.08 to 9.12) and 0.11 (95% CI, 0.04 to 0.17), respectively. The duration of surgery, blood loss, number of patients requiring transfusion, and analgesic requirements favored the MIS group with a significant difference. Open surgery is better than MIS in achieving a better correction rate and good functional outcomes. MIS is better over open surgery when perioperative parameters are considered.

Etiopathogenesis of adolescent idiopathic scoliosis: Review of the literature and new epigenetic hypothesis on altered neural crest cells migration in early embryogenesis as the key event

Adolescent idiopathic scoliosis (AIS) affects 2-3% of children. Numerous hypotheses on etiologic/causal factors of AIS were investigated, but all failed to identify therapeutic targets and hence failed to offer a cure. Therefore, currently there are only two options to minimize morbidity of the patients suffering AIS: bracing and spinal surgery. From the beginning of 1960th, spinal surgery, both fusion and rod placement, became the standard of management for progressive adolescent idiopathic spine deformity. However, spinal surgery is often associated with complications. These circumstances motivate AIS scientific community to continue the search for new etiologic and causal factors of AIS. While the role of the genetic factors in AIS pathogenesis was investigated intensively and universally recognized, these studies failed to nominate mutation of a particular gene or genes combination responsible for AIS development. More recently epigenetic factors were suggested to play causal role in AIS pathogenesis. Sharing this new approach, we investigated scoliotic vertebral growth plates removed during vertebral fusion (anterior surgery) for AIS correction. In recent publications we showed that cells from the convex side of human scoliotic deformities undergo normal chondrogenic/osteogenic differentiation, while cells from the concave side acquire a neuronal phenotype. Based on these facts we hypothesized that altered neural crest cell migration in early embryogenesis can be the etiological factor of AIS. In particular, we suggested that neural crest cells failed to migrate through the anterior half of somites and became deposited in sclerotome, which in turn produced chondrogenic/osteogenic-insufficient vertebral growth plates. To test this hypothesis we conducted experiments on chicken embryos with arrest neural crest cell migration by inhibiting expression of Paired-box 3 (Pax3) gene, a known enhancer and promoter of neural crest cells migration and differentiation. The results showed that chicken embryos treated with Pax3 siRNA (microinjection into the neural tube, 44 h post-fertilization) progressively developed scoliotic deformity during maturation. Therefore, this analysis suggests that although adolescent idiopathic scoliosis manifests in children around puberty, the real onset of the disease is of epigenetic nature and takes place in early embryogenesis and involves altered neural crest cells migration. If these results confirmed and further elaborated, the hypothesis may shed new light on the etiology and pathogenesis of AIS.

Minimally invasive surgery versus standard posterior approach for Lenke Type 1-4 adolescent idiopathic scoliosis: a multicenter, retrospective study

PURPOSE

To compare the safety and efficacy of posterior minimally invasive surgery (MIS) to standard posterior spinal fusion (PSF) surgery for Lenke Type 1-4 adolescent idiopathic scoliosis (AIS).

METHODS

This multicenter retrospective study enrolled 112 patients with Lenke Type 1-4 AIS who treated with MIS (n = 64) or PSF (n = 48) between March 2007 and January 2015. Coronal and sagittal parameters were evaluated before surgery, immediately after surgery, and at the last follow-up. Operative time, level of fusion, intraoperative blood loss, blood transfusion, and intraoperative radiation exposure were recorded. 22-item Scoliosis Research Society questionnaire (SRS-22) was applied for assessment of life quality. The accuracy of pedicle screw placement was assessed according to postoperative computed tomography images, and the complications were collected in follow-up period.

RESULTS

The baseline characteristics of 2 groups were matched. There was no significant difference between 2 groups in terms of radiographic parameters immediately after surgery and at the last follow-up. The MIS group had significantly longer operative time, more level of fusion, less intraoperative blood loss, and lower blood transfusion rate (p < 0.001). The evaluation of pain using SRS-22 showed significantly lower score in MIS group (p < 0.05). No significant difference was found between 2 groups in terms of accuracy of pedicle screw placement and complications.

CONCLUSION

Posterior MIS is a safe and effective alternative to standard open approach for Lenke Type 1-4 AIS patients with curves < 70° and reasonable flexibility. Mid-term results showed MIS had the advantages of less blood loss and pain with more fusion segments.

Conventional versus stereotactic image guided pedicle screw placement during spinal deformity correction: a retrospective propensity score-matched study of a national longitudinal database

PURPOSE/AIM

To compare complications, readmissions, revisions, and payments between navigated and conventional pedicle screw fixation for treatment of spine deformity.

METHODS

The Thomson Reuters MarketScan national longitudinal database was used to identify patients undergoing osteotomy, posterior instrumentation, and fusion for treatment of spinal deformity with or without image-guided navigation between 2007-2016. Conventional and navigated groups were propensity-matched (1:1) to normalize differences between demographics, comorbidities, and surgical characteristics. Clinical outcomes and charges were compared between matched groups using bivariate analyses.

RESULTS

A total of 4,604 patients were identified as having undergone deformity correction, of which 286 (6.2%) were navigated. Propensity-matching resulted in a total of 572 well-matched patients for subsequent analyses, of which half were navigated. Rate of mechanical instrumentation-related complications was found to be significantly lower for navigated procedures (p = 0.0371). Navigation was also associated with lower rates of 90-day unplanned readmissions (p = 0.0295), as well as 30- and 90-day postoperative revisions (30-day: p = 0.0304, 90-day: p = 0.0059). Hospital, physician, and total payments favored the conventional group for initial admission (p = 0.0481, 0.0001, 0.0019, respectively); however, when taking into account costs of readmissions, hospital payments became insignificantly different between the two groups.

CONCLUSIONS

Procedures involving image-guided navigation resulted in decreased instrumentation-related complications, unplanned readmissions, and postoperative revisions, highlighting its potential utility for the treatment of spine deformity. Future advances in navigation technologies and methodologies can continue to improve clinical outcomes, decrease costs, and facilitate widespread adoption of navigation for deformity correction.

Minimal invasive surgery techniques for patients with adolescent idiopathic and early onset scoliosis

OBJECTIVE

Provide an update on minimal invasive surgery (MIS) techniques for surgical management of pediatric spine.

METHODS

Minimal Invasive surgery for pediatric spine deformity has evolved significantly over the past decade. We include updated information about the surgical management of patients with adolescent idiopathic and Early Onset Scoliosis through MIS techniques. We take into consideration the implementation of this technique in Low-to-Middle Income Countries (LMICs).

RESULTS

Although MIS began as a technique in adult and degenerative spine, recent publications on MIS in pediatric spine cases report benefits of decreased blood loss and infection incidence, and cosmetic advantages from fewer incision numbers. Adoption of MIS techniques in pediatric spine can be facilitated with pre- and intraoperative use of pertinent medical systems.

CONCLUSION

With appropriate considerations and training, MIS is a safe procedure for pediatric spine correction surgery and can be applicable in LMICs.