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Abstract
Introduction
Minimally invasive surgical (MIS) techniques are gaining popularity in the treatment of adult spinal deformity (ASD). The premise is that MIS techniques will lead to equivalent outcomes and a reduction in perioperative complications when compared with open techniques. Potential issues with MIS techniques are a limited capacity to correct lumbar lordosis, unknown long-term efficacy, and the potential need for revision surgery. This study compares reoperation rates and reasons for reoperation following MIS, hybrid, and open surgery for ASD through multicenter database analysis.
Methods
We retrospectively analyzed a prospective multicenter ASD database comparing open and MIS correction techniques. Inclusion criteria were: age > 18 years with minimum 20° coronal lumbar Cobb angle, a minimum of three levels fused, and minimum 2-year follow-up. Patients were propensity matched for preoperative sagittal vertebral axis (SVA), pelvic incidence–lumbar lordosis (PI–LL), and number of levels fused. We included 189 patients from three propensity-matched subgroups of 63 patients each: (1) MIS: lateral or transforaminal lumbar interbody fusion (LIF) and percutaneous pedicle instrumentation, (2) Hybrid: MIS LIF with open posterior segmental fixation (PSF), and (3) OPEN: open posterior fixation ± osteotomies.
Results
With propensity matching, there were significant differences between groups in pre-op SVA or PI–LL (p > 0.05). The MIS group had significantly fewer levels fused (5.4) (0–14) than the OPEN group (7.4) (p = 0.002) (0–17). The rate of revision surgery was significantly different between the groups with a higher rate of revision (27 %) amongst the HYB group versus MIS = 11.1 %, and OPEN = 12.0 %. The most common reason for reoperation in the OPEN and HYB groups was a postoperative neurological deficit (7.9 and 11.1 %), respectively. The most common reason for reoperation in the MIS group was pseudoarthrosis (7.9 %).
Conclusions
Reoperation rates were not statistically different among the MIS, and OPEN surgical groups, but differed significantly on multivariate analysis with HYB group. The incidence of reoperations was twice as high in the Hybrid group compared to OPEN and MIS.
Details
1 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
2 Geisinger Neurosurgery, Geisinger Medical Center, Danville, PA, USA
3 San Diego Center for Spinal Disorders, La Jolla, CA, USA
4 Department of Neurosurgery, University of California San Francisco Medical Center, San Francisco, CA, USA
5 Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
6 Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
7 Department of Orthopedic Surgery, NYU Hospital for Joint Disease, New York, NY, USA
8 Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA
9 Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
10 Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
11 Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA