Department of Surgery, Cedars-Sinai Spine Center, Los Angeles, California.
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
Neurosurgery. 2017 Nov 1;81(5):733-739. doi: 10.1093/neuros/nyx353.
Minimally invasive surgery (MIS) techniques used for management of adult spinal deformity (ASD) aim to decrease the physiological demand on patients and minimize postoperative complications. A circumferential MIS (cMIS) protocol offers the potential to maximize this advantage over standard open approaches, through the concurrent use of multiple MIS techniques.
To demonstrate through a case example the execution of a cMIS protocol for management of an ASD patient with severe deformity.
Thorough preoperative assessment, surgical planning, and medical optimization were completed. Deformity correction was performed over 2 stages. During the first stage, interbody fusion was performed via an oblique lateral approach at all levels of the lumbar spine intended to be included in the final construct. The patient was kept as an inpatient and mobilized postoperatively. They were then re-imaged with standing films. The second stage occurred after 3 d and involved percutaneous instrumentation of all levels. Posterior fusion of the thoracic levels was achieved through decortication of pars and facets. These areas were accessed through the intermuscular plane established by the percutaneous screws. The patient was mobilizing on their first postoperative day.
In a 66-yr-old female with severe sagittal imbalance and debilitating back pain, effective use of this cMIS protocol allowed for correction of the Cobb angle from 52° to 4° correction of spinopelvic parameters and 13 cm of sagittal vertical axis improvement. No complications were identified by 2 yr postoperative.
As a systematization of multiple MIS techniques combined, in a specific and staged manner, this cMIS protocol could provide a safe and effective approach to the management of ASD.
用于治疗成人脊柱畸形（ASD）的微创手术（MIS）技术旨在降低患者的生理需求并最小化术后并发症。环形 MIS（cMIS）方案通过同时使用多种 MIS 技术，有可能比标准的开放方法最大限度地发挥这一优势。
通过一个病例示例展示用于治疗严重畸形 ASD 患者的 cMIS 方案的实施过程。
完成了彻底的术前评估、手术计划和医疗优化。通过 2 个阶段进行畸形矫正。在第一阶段，通过斜外侧入路在所有计划包含在最终构建中的腰椎水平进行椎间融合。患者住院并在术后进行了移动。然后对其进行站立位 X 线片的重新成像。第二阶段发生在 3 天后，涉及所有水平的经皮器械固定。通过对椎板和小关节进行减压来实现胸椎的后路融合。通过经皮螺钉建立的肌间平面来进入这些区域。患者在术后第一天就开始活动。
在一名 66 岁的女性中，存在严重的矢状面失衡和使人虚弱的背痛，有效使用这种 cMIS 方案使 Cobb 角从 52°矫正到 4°，使脊柱骨盆参数得到矫正，矢状垂直轴改善了 13 厘米。术后 2 年未发现任何并发症。
作为多种 MIS 技术的综合系统，以特定和分阶段的方式，这种 cMIS 方案可以为 ASD 的治疗提供一种安全有效的方法。
