J Neurosurg Pediatr. 2017 Apr;19(4):472-478. doi: 10.3171/2016.11.PEDS16412. Epub 2017 Feb 10.
OBJECTIVE Recently, minimally invasive scoliosis surgery (MISS) was introduced for the correction of adult scoliosis. Multiple benefits including a good deformity correction rate and fewer complications have been demonstrated. However, few studies have reported on the use of MISS for the management of adolescent idiopathic scoliosis (AIS). The purpose of this study was to investigate the outcome of posterior MISS assisted by O-arm navigation for the correction of Lenke Type 5C AIS. METHODS The authors searched a database for all patients with AIS who had been treated with either MISS or PSF between November 2012 and January 2014. Levels of fusion, density of implants, operation time, and estimated blood loss (EBL) were recorded. Coronal and sagittal parameters were evaluated before surgery, immediately after surgery, and at the last follow-up. The accuracy of pedicle screw placement was assessed according to postoperative axial CT images in both groups. The 22-item Scoliosis Research Society questionnaire (SRS-22) results and complications were collected during follow-up. RESULTS The authors retrospectively reviewed the records of 45 patients with Lenke Type 5C AIS, 15 who underwent posterior MISS under O-arm navigation and 30 who underwent posterior spinal fusion (PSF). The 2 treatment groups were matched in terms of baseline characteristics. Comparison of radiographic parameters revealed no obvious difference between the 2 groups immediately after surgery or at the final follow-up; however, the MISS patients had significantly less EBL (p < 0.001) and longer operation times (p = 0.002). The evaluation of pain and self-image using the SRS-22 showed significantly higher scores in the MISS group (p = 0.013 and 0.046, respectively) than in the PSF group. Postoperative CT showed high accuracy in pedicle placement in both groups. No deep wound infection, pseudarthrosis, additional surgery, implant failure, or neurological complications were recorded in either group. CONCLUSIONS Minimally invasive scoliosis surgery is an effective and safe alternative to open surgery for patients with Lenke Type 5C AIS. Compared with results of the open approach, the outcomes of MISS are promising, with reduced morbidity. Before the routine use of MISS, however, long-term data are needed.
目的 近年来，微创脊柱侧弯手术（MISS）被用于成人脊柱侧弯的矫正。已证实其具有多种益处，包括良好的畸形矫正率和较少的并发症。然而，很少有研究报道MISS用于青少年特发性脊柱侧弯（AIS）的治疗。本研究的目的是探讨在O型臂导航辅助下后路MISS矫正Lenke 5C型AIS的疗效。方法 作者检索数据库，纳入2012年11月至2014年1月期间接受MISS或后路脊柱融合术（PSF）治疗的所有AIS患者。记录融合节段、植入物密度、手术时间和估计失血量（EBL）。在术前、术后即刻及末次随访时评估冠状面和矢状面参数。根据术后轴向CT图像评估两组椎弓根螺钉置入的准确性。随访期间收集22项脊柱侧弯研究学会问卷（SRS-22）结果及并发症情况。结果 作者回顾性分析了45例Lenke 5C型AIS患者的记录，其中15例行O型臂导航辅助下后路MISS，30例行后路脊柱融合术（PSF）。两组患者的基线特征相匹配。影像学参数比较显示，术后即刻或末次随访时两组之间无明显差异；然而，MISS组患者的EBL明显较少（p < 0.001），手术时间较长（p = 0.002）。使用SRS-22对疼痛和自我形象的评估显示，MISS组的得分显著高于PSF组（分别为p = 0.013和0.046）。术后CT显示两组椎弓根置入的准确性均较高。两组均未记录到深部伤口感染、假关节形成、再次手术、植入物失败或神经并发症。结论 对于Lenke 5C型AIS患者，微创脊柱侧弯手术是开放手术的一种有效且安全的替代方法。与开放手术结果相比，MISS的疗效令人满意，发病率降低。然而，在常规使用MISS之前，需要长期数据。
