Lovecchio Francis, Qureshi Sheeraz A
Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10017, USA.
Weill Cornell Medical College, New York, NY, USA.
Curr Rev Musculoskelet Med. 2019 Jul 16;12(3):318-327. doi: 10.1007/s12178-019-09570-6.
Minimally invasive approaches to adult spinal deformity (ASD) surgery have seen a large increase in popularity over the last decade, largely because these techniques are viewed as a potential improvement to the lengthy recovery and high complication rates observed after traditional open surgery for this pathology. The purpose of this review is to present a summary of the latest minimally invasive techniques used in adult spinal deformity surgery, examine whether MIS surgery can accomplish the goals of ASD surgery, and investigate whether MIS surgery is safer than traditional approaches.
While minimally invasive approaches have been able to achieve similar patient-reported outcomes as open approaches, they are associated with their own unique complications. Furthermore, they are limited in their ability to correct severe sagittal imbalance. Emerging techniques, such as anterior column realignment and mini-open posterior column osteotomy, have been developed to address these limitations. The minimally invasive spinal deformity surgery algorithm (MISDEF) can help guide surgeons on which approaches may be appropriate for a particular case. To maximize the benefits of a minimally invasive approach without compromising the goals of ASD surgery, surgeons must be selective in choosing which cases are amenable to an MIS approach. Leading experts continue to develop algorithms to guide surgical decision-making. As we learn to better define our indications, understand treatment goals, and refine our techniques, MIS approaches will likely play an even larger role in a comprehensive ASD treatment strategy.
在过去十年中，成人脊柱畸形（ASD）手术的微创方法越来越受欢迎，主要是因为这些技术被视为对传统开放手术治疗该疾病后漫长恢复时间和高并发症发生率的潜在改进。本综述的目的是总结成人脊柱畸形手术中使用的最新微创技术，研究微创（MIS）手术是否能实现ASD手术的目标，并探讨MIS手术是否比传统方法更安全。
虽然微创方法能够取得与开放方法相似的患者报告结局，但它们也有其独特的并发症。此外，它们在纠正严重矢状面失衡方面的能力有限。已经开发出诸如前柱重建和迷你开放后柱截骨术等新兴技术来解决这些局限性。微创脊柱畸形手术算法（MISDEF）可以帮助指导外科医生哪种方法可能适用于特定病例。为了在不影响ASD手术目标的情况下最大限度地发挥微创方法的益处，外科医生在选择哪些病例适合MIS方法时必须谨慎。顶尖专家继续开发算法以指导手术决策。随着我们学会更好地界定适应症、理解治疗目标并完善技术，MIS方法可能会在全面的ASD治疗策略中发挥更大的作用。
