Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
World Neurosurg. 2019 Jun;126:e860-e868. doi: 10.1016/j.wneu.2019.03.001. Epub 2019 Mar 9.
We determined the feasibility of minimally invasive surgery for severe adult spinal deformities and proposed a reassessment system and staged minimally invasive surgical strategy.
We treated 53 patients from June 2016 to August 2017 using a reassessment system and a staged surgical strategy with minimally invasive techniques for minimally invasive spinal deformity surgery, class III. Patients with scoliotic apex vertebrae above L1-L2 or spontaneous fusion of the facet joints were excluded. The reassessment system was applied. The first stage involved multisegmental lateral lumbar interbody fusion and anterior column realignment (ACR), and the second stage involved posterior minimally invasive surgery. The pre- and postoperative visual analog scale scores, Oswestry disability index, surgical data, and radiographic images were collected. The major and minor complications were recorded.
All the patients were followed up for 11.5 months (range, 6-20). Lateral lumbar interbody fusion was performed in 168 segments, of which 113 had ACR. The average sagittal correction angle of each ACR segment was 15.6° ± 6.3° (range, 7°-28°). The correction rate of the Cobb angle for lumbar scoliosis after first stage was 55.4%, and the total correction rate was 75.6%. The lumbar lordosis-pelvic index mismatch was improved from -32.8° ± 14.9° to -2.5° ± 9.4°, reaching the sagittal matching state of the lumbar spine.
A reassessment system and minimally invasive staged surgery for severe adult spinal deformity can achieve good clinical outcomes and deformity correction and might have the advantage of decreasing unnecessary iatrogenic injury.
我们旨在确定微创治疗重度成人脊柱畸形的可行性，并提出了一种再评估系统和分期微创外科策略。
我们采用再评估系统和分期微创外科策略，对 2016 年 6 月至 2017 年 8 月的 53 例脊柱畸形 III 类患者进行微创脊柱畸形手术治疗。排除顶椎位于 L1-L2 以上或关节突自发性融合的脊柱侧凸患者。应用再评估系统，第一阶段包括多节段侧方腰椎椎间融合和前方柱矫正（ACR），第二阶段采用后路微创技术。收集患者术前和术后的视觉模拟评分、Oswestry 功能障碍指数、手术数据和影像学图像，记录主要和次要并发症。
所有患者均获得 11.5 个月（6-20 个月）的随访。共行 168 个节段的侧方腰椎椎间融合，其中 113 个节段行 ACR。每个 ACR 节段矢状面矫正角度的平均为 15.6°±6.3°（7°-28°）。第一阶段后路腰椎侧凸矫正 Cobb 角的矫正率为 55.4%，总矫正率为 75.6%。腰椎前凸-骨盆指数失配从-32.8°±14.9°改善至-2.5°±9.4°，达到腰椎矢状面对位状态。
重度成人脊柱畸形的再评估系统和微创分期手术可以获得良好的临床效果和矫形效果，并可能具有减少不必要医源性损伤的优势。
