1Department of Neurological Surgery, University of California, San Francisco, California.
2Scripps Clinic, La Jolla, California.
J Neurosurg Spine. 2021 Nov 5;36(4):595-608. doi: 10.3171/2021.7.SPINE21138. Print 2022 Apr 1.
Previous studies have demonstrated the short-term radiographic and clinical benefits of circumferential minimally invasive surgery (cMIS) and hybrid (i.e., minimally invasive anterior or lateral interbody fusion with an open posterior approach) techniques to correct adult spinal deformity (ASD). However, it is not known if these benefits are maintained over longer periods of time. This study evaluated the 2- and 3-year outcomes of cMIS and hybrid correction of ASD.
A multicenter database was retrospectively reviewed for patients undergoing cMIS or hybrid surgery for ASD. Patients were ≥ 18 years of age and had one of the following: maximum coronal Cobb angle (CC) ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic incidence-lumbar lordosis mismatch (PI-LL) ≥ 10°, or pelvic tilt (PT) > 20°. Radiographic parameters were evaluated at the latest follow-up. Clinical outcomes were compared at 2- and 3-year time points and adjusted for age, preoperative CC, levels operated, levels with interbody fusion, presence of L5-S1 anterior lumbar interbody fusion, and upper and lower instrumented vertebral level.
Overall, 197 (108 cMIS, 89 hybrid) patients were included with 187 (99 cMIS, 88 hybrid) and 111 (60 cMIS, 51 hybrid) patients evaluated at 2 and 3 years, respectively. The mean (± SD) follow-up duration for cMIS (39.0 ± 13.3 months, range 22-74 months) and hybrid correction (39.9 ± 16.8 months, range 22-94 months) were similar for both cohorts. Hybrid procedures corrected the CC greater than the cMIS technique (adjusted p = 0.022). There were no significant differences in postoperative SVA, PI-LL, PT, and sacral slope (SS). At 2 years, cMIS had lower Oswestry Disability Index (ODI) scores (adjusted p < 0.001), greater ODI change as a percentage of baseline (adjusted p = 0.006), less visual analog scale (VAS) back pain (adjusted p = 0.006), and greater VAS back pain change as a percentage of baseline (adjusted p = 0.001) compared to hybrid techniques. These differences were no longer significant at 3 years. At 3 years, but not 2 years, VAS leg pain was lower for cMIS compared to hybrid techniques (adjusted p = 0.032). Those undergoing cMIS had fewer overall complications compared to hybrid techniques (adjusted p = 0.006), but a higher odds of pseudarthrosis (adjusted p = 0.039).
In this review of a multicenter database for patients undergoing cMIS and hybrid surgery for ASD, hybrid procedures were associated with a greater CC improvement compared to cMIS techniques. cMIS was associated with superior ODI and back pain at 2 years, but this difference was no longer evident at 3 years. However, cMIS was associated with superior leg pain at 3 years. There were fewer complications following cMIS, with the exception of pseudarthrosis.
先前的研究已经证明了环形微创外科（cMIS）和混合（即微创前路或侧方椎间融合术联合后路开放性手术）技术在矫正成人脊柱畸形（ASD）方面的短期影像学和临床获益。然而，目前尚不清楚这些益处是否能在较长时间内维持。本研究评估了 cMIS 和混合矫正 ASD 的 2 年和 3 年结果。
回顾性分析了接受 cMIS 或混合手术治疗 ASD 的多中心数据库。患者年龄≥18 岁，符合以下一项或多项标准：最大冠状 Cobb 角（CC）≥20°，矢状垂直轴（SVA）>5cm，骨盆入射角-腰椎前凸角（PI-LL）不匹配≥10°，或骨盆倾斜角（PT）>20°。在末次随访时评估影像学参数。比较 2 年和 3 年的临床结果，并根据年龄、术前 CC、手术节段数、行椎间融合术的节段数、L5-S1 前路腰椎间融合术的存在情况以及上下置入物节段进行调整。
共纳入 197 例（108 例 cMIS，89 例混合）患者，分别有 187 例（99 例 cMIS，88 例混合）和 111 例（60 例 cMIS，51 例混合）患者在 2 年和 3 年时进行了评估。cMIS（39.0±13.3 个月，范围 22-74 个月）和混合矫正（39.9±16.8 个月，范围 22-94 个月）的平均（±标准差）随访时间在两组间相似。混合手术矫正 CC 的效果优于 cMIS 技术（校正 p=0.022）。术后 SVA、PI-LL、PT 和骶骨倾斜角（SS）无显著差异。2 年时，cMIS 的 Oswestry 功能障碍指数（ODI）评分较低（校正 p<0.001），ODI 变化百分比基线更高（校正 p=0.006），视觉模拟量表（VAS）腰痛评分较低（校正 p=0.006），VAS 腰痛变化百分比基线更高（校正 p=0.001）。这些差异在 3 年时不再显著。3 年时，与混合技术相比，cMIS 的 VAS 腿痛评分较低（校正 p=0.032），但 2 年时无显著差异。与混合技术相比，cMIS 的总体并发症较少（校正 p=0.006），但假关节形成的可能性更高（校正 p=0.039）。
在这项对多中心数据库中接受 cMIS 和混合手术治疗 ASD 的患者进行的回顾性研究中，与 cMIS 技术相比，混合手术与更大的 CC 改善相关。cMIS 在 2 年时与 ODI 和腰痛改善相关，但在 3 年时这种差异不再明显。然而，cMIS 在 3 年时与腿痛改善相关。cMIS 术后并发症较少，除外假关节形成。
