Fiore Michele, Ruffilli Alberto, Viroli Giovanni, Barile Francesca, Manzetti Marco, Faldini Cesare
Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Alma Mater Studiorum - University of Bologna, Bologna, Italy.
J Clin Neurosci. 2022 May;99:317-326. doi: 10.1016/j.jocn.2022.03.019. Epub 2022 Mar 24.
Minimally invasive surgery (MIS) techniques for posterior spine pedicle-screw fusion (PSF) may reduce the AIS surgery invasiveness, although they require a certain degree of patient selection based on the severity of the curve. The aim of this article is to systematically review the Literature to determine efficacy and safety of MIS-PSF in AIS correction, and to compare its outcomes with open-PSF. A systematic search of electronic databases from eligible articles was conducted. Only studies adopting MIS-PSF for AIS were included. Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed. P-value < 0.05 was considered significant. Thirteen studies for a total of 635 patients ungergoing MIS-PSF were included in this review. Pre-operative Cobb's angle ranged from 48.3°±4.2° to 59.8°±6.6°, coronal correction from 58.1% to 79.1%, average operative time ranged from 252 to 526.8 min, average estimated blood loss from 138.8 ± 50 to 1250 mL. Sixty-seven complications were recorded (9.9%), with 19 revisions (3.8%), resulting similar to those described in Literature using open-PSF. At meta-analysis, MIS-PSF (321 patients) compared to open-PSF (429 patients) showed lower coronal correction (although no statistically significant difference was found), estimated blood loss and length of hospital stay, but higher operative time. No differences in SRS-22, complications and revision rate were found. In conclusion, open-PSF shows a trend towards higher correction in the coronal plane and requires a shorter operative time when compared to MIS-PSF. It remains the gold standard for AIS correction, although MIS-PSF seems to be a viable and promising technique for selected patients. - KEYWORDS: minimally invasive surgery, minimally invasive techniques, adolescent idiopathic scoliosis, posterior spinal fusion, pedicle-screws-only instrumentation.
用于后路脊柱椎弓根螺钉融合术（PSF）的微创手术（MIS）技术可能会降低青少年特发性脊柱侧凸（AIS）手术的侵入性，尽管它们需要根据侧弯的严重程度对患者进行一定程度的筛选。本文的目的是系统回顾文献，以确定MIS-PSF在AIS矫正中的疗效和安全性，并将其结果与开放PSF进行比较。对符合条件的文章的电子数据库进行了系统检索。仅纳入采用MIS-PSF治疗AIS的研究。提取并总结了临床和影像学结果。进行了荟萃分析。P值<0.05被认为具有统计学意义。本综述纳入了13项研究，共635例接受MIS-PSF的患者。术前Cobb角范围为48.3°±4.2°至59.8°±6.6°，冠状面矫正率为58.1%至79.1%，平均手术时间范围为252至526.8分钟，平均估计失血量为138.8±50至1250毫升。记录了67例并发症（9.9%），19例翻修手术（3.8%），结果与文献中使用开放PSF描述的相似。在荟萃分析中，与开放PSF（429例患者）相比，MIS-PSF（321例患者）的冠状面矫正率较低（尽管未发现统计学显著差异），估计失血量和住院时间较短，但手术时间较长。在SRS-22、并发症和翻修率方面未发现差异。总之，与MIS-PSF相比，开放PSF在冠状面显示出更高矫正的趋势，且手术时间更短。它仍然是AIS矫正的金标准，尽管MIS-PSF似乎是适合特定患者的一种可行且有前景的技术。 - 关键词：微创手术、微创技术、青少年特发性脊柱侧凸、后路脊柱融合术、仅椎弓根螺钉内固定术
