Hamilton D Kojo, Kanter Adam S, Bolinger Bryan D, Mundis Gregory M, Nguyen Stacie, Mummaneni Praveen V, Anand Neel, Fessler Richard G, Passias Peter G, Park Paul, La Marca Frank, Uribe Juan S, Wang Michael Y, Akbarnia Behrooz A, Shaffrey Christopher I, Okonkwo David O
Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA, 15213, USA.
Geisinger Neurosurgery, Geisinger Medical Center, Danville, PA, USA.
Eur Spine J. 2016 Aug;25(8):2605-11. doi: 10.1007/s00586-016-4443-2. Epub 2016 Feb 24.
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.
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.
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 %).
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.
微创外科（MIS）技术在成人脊柱畸形（ASD）治疗中越来越受欢迎。其前提是与开放技术相比，MIS技术将带来等效的治疗效果并减少围手术期并发症。MIS技术存在的潜在问题包括纠正腰椎前凸的能力有限、长期疗效未知以及可能需要翻修手术。本研究通过多中心数据库分析比较了MIS、混合和开放手术治疗ASD后的再次手术率及再次手术原因。
我们回顾性分析了一个前瞻性多中心ASD数据库，比较开放和MIS矫正技术。纳入标准为：年龄>18岁，冠状面腰椎Cobb角至少20°，至少融合三个节段，且随访至少2年。患者根据术前矢状位脊柱轴线（SVA）、骨盆入射角-腰椎前凸（PI-LL）和融合节段数进行倾向匹配。我们纳入了来自三个倾向匹配亚组的189例患者，每组63例：（1）MIS组：外侧或经椎间孔腰椎椎间融合术（LIF）及经皮椎弓根内固定；（2）混合组：MIS LIF联合开放后路节段性固定（PSF）；（3）开放组：开放后路固定±截骨术。
经倾向匹配后，术前SVA或PI-LL在各组间无显著差异（p>0.05）。MIS组融合节段数（5.4）（0-14）显著少于开放组（7.4）（p=0.002）（0-17）。各组间翻修手术率有显著差异，混合组翻修率较高（27%），而MIS组为11.1%，开放组为12.0%。开放组和混合组再次手术最常见的原因分别是术后神经功能缺损（7.9%和11.1%）。MIS组再次手术最常见的原因是假关节形成（7.9%）。
MIS组和开放手术组的再次手术率在统计学上无差异，但在多因素分析中与混合组有显著差异。混合组的再次手术发生率是开放组和MIS组的两倍。
