Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA.
Neurosurg Rev. 2021 Apr;44(2):659-668. doi: 10.1007/s10143-020-01280-9. Epub 2020 Mar 12.
While open surgery has been the primary surgical approach for adult degenerative scoliosis, minimally invasive surgery (MIS) represents an alternative option and appears to be associated with reduced morbidity. Given the lack of consensus, we aimed to conduct a systematic review on available literature comparing MIS versus open surgery for adult degenerative scoliosis. PubMed, Embase, and Cochrane databases were searched through December 16, 2019, for studies that compared both MIS and open surgery in patients with degenerative scoliosis. Four cohort studies reporting on 350 patients met the inclusion criteria. In two studies, patients undergoing open surgery were younger and had more severe disease at baseline as compared with MIS. Patients who underwent MIS had less blood loss, shorter length of stay, and a reduced rate of complications and infections. Both MIS and open surgery resulted in a significant change in pain and disability scores and both approaches provided significant correction of deformity in all studies, although open surgery was associated with a greater change in pelvic incidence-lumbar lordosis mismatch (PI-LL) and sagittal vertical axis (SVA) in two and three studies, respectively. In patients with adult degenerative scoliosis undergoing surgery, both MIS and open approaches appeared to offer comparable improvements in pain and function. However, MIS was associated with better safety outcomes, while open surgery provided greater correction of spinal deformity. Further studies are needed to identify specific subset of patients who may benefit from one approach versus the other.
虽然开放性手术一直是成人退行性脊柱侧凸的主要手术方法，但微创手术 (MIS) 是一种替代方法，似乎与降低发病率有关。鉴于缺乏共识，我们旨在对现有文献进行系统评价，比较成人退行性脊柱侧凸的 MIS 与开放性手术。通过 2019 年 12 月 16 日检索 PubMed、Embase 和 Cochrane 数据库，查找比较退行性脊柱侧凸患者 MIS 和开放性手术的研究。四项队列研究报告了 350 例符合纳入标准的患者。在两项研究中，接受开放性手术的患者年龄较小，基线时疾病更严重。接受 MIS 治疗的患者失血量较少，住院时间较短，并发症和感染发生率较低。MIS 和开放性手术均显著改善疼痛和残疾评分，所有研究均显著矫正畸形，但开放性手术与骨盆入射角-腰椎前凸角不匹配（PI-LL）和矢状垂直轴（SVA）的变化更大，分别在两项和三项研究中。在接受手术治疗的成人退行性脊柱侧凸患者中，MIS 和开放性手术似乎都能在疼痛和功能方面提供相当的改善。然而，MIS 与更好的安全性结果相关，而开放性手术则能更好地矫正脊柱畸形。需要进一步的研究来确定哪些特定的患者群体可能从一种方法中受益。
