Li Bo, Hawryluk Gregory, Mummaneni Praveen V, Wang Michael, Mehra Ratnesh, Wang Minghao, Lau Darryl, Mayer Rory, Fu Kai-Ming, Chou Dean
Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA.
Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Neurospine. 2021 Dec;18(4):824-832. doi: 10.14245/ns.2142508.254. Epub 2021 Dec 31.
Long-segment fusion in adult spinal deformity (ASD) is often needed, but more focal surgeries may provide significant relief with less morbidity. The minimally invasive spinal deformity surgery (MISDEF2) algorithm guides minimally invasive ASD surgery, but it may be useful in open ASD surgery. We classified ASD patients undergoing focal decompression, limited decompression and fusion, and full correction according to MISDEF2 and correlated outcomes.
A retrospective study of ASD patients treated by 2 surgeons at our hospital was performed. Inclusion criteria were: age > 50, minimum 2-year follow-up, and open ASD surgery. Tumor, trauma, and infections were excluded. Patients had open surgery including focal decompression, short segment fusion, or full scoliosis correction. All patients were categorized by MISDEF2 into 4 classes based upon spinopelvic parameters. Perioperative metrics were assessed. Radiographic correction, complications and reoperation were recorded.
A total of 136 patients met inclusion criteria. Mean follow-up was 46 ± 15.8 months (range, 24-118 months). Forty-seven underwent full deformity correction, 71 underwent short segment fusion, and 18 underwent decompression alone. There were 24 cases of class I, 66 cases of class II, 23 cases of class III, and 23 cases of class IV patients. Patients in class I and II had perioperative complication rates of 0% and 16.7% and revision rates of 8% and 21.2% when undergoing focal decompression or limited fusion. However, class II patients undergoing full correction had higher perioperative complications rate (p = 0.03) and revision surgery rates (p = 0.047). This difference was not seen in class III patients (p > 0.05). All class IV patients underwent full correction, but they had higher perioperative complication rates (p < 0.019), comparable revision surgery rates (p = 0.27), and better radiographic realignment (p < 0.001). In addition, full deformity correction was associated with longer length of stay, increased blood loss, and longer operative time (p < 0.001).
The MISDEF2 algorithm may help guide ASD surgical decision making even in open surgery, with focal treatment used in class I and II patients as a viable alternative and full correction implemented in class IV patients because of severe malalignment. However, class II patients with ASD undergoing full deformity correction do have higher complication rates.
成人脊柱畸形（ASD）通常需要进行长节段融合，但更多的局部手术可能以较低的发病率提供显著缓解。微创脊柱畸形手术（MISDEF2）算法指导微创ASD手术，但它在开放性ASD手术中可能也有用。我们根据MISDEF2对接受局部减压、有限减压融合和完全矫正的ASD患者进行分类并关联结果。
对我院两位外科医生治疗的ASD患者进行回顾性研究。纳入标准为：年龄>50岁，至少随访2年，且为开放性ASD手术。排除肿瘤、创伤和感染患者。患者接受包括局部减压、短节段融合或全脊柱侧弯矫正的开放性手术。所有患者根据MISDEF2基于脊柱骨盆参数分为4类。评估围手术期指标。记录影像学矫正、并发症和再次手术情况。
共有136例患者符合纳入标准。平均随访时间为46±15.8个月（范围24 - 118个月）。47例患者接受了全畸形矫正，71例患者接受了短节段融合，18例患者仅接受了减压。I类患者24例，II类患者66例，III类患者23例，IV类患者23例。I类和II类患者在接受局部减压或有限融合时，围手术期并发症发生率分别为0%和16.7%，翻修率分别为8%和21.2%。然而，II类患者接受全矫正时围手术期并发症发生率更高（p = 0.03），翻修手术率更高（p = 0.047）。III类患者未观察到这种差异（p>0.05）。所有IV类患者均接受了全矫正，但他们围手术期并发症发生率更高（p<0.019），翻修手术率相当（p = 0.27），影像学对线更好（p<0.001）。此外，全畸形矫正与住院时间延长、失血量增加和手术时间延长相关（p<0.001）。
MISDEF2算法即使在开放性手术中也可能有助于指导ASD手术决策，I类和II类患者采用局部治疗是可行的选择，IV类患者由于严重畸形不对齐而进行全矫正。然而，接受全畸形矫正的II类ASD患者确实有更高的并发症发生率。
