Kim Hong Jin, Lenke Lawrence G, Pizones Javier, Castelein René, Trobisch Per D, Yagi Mitsuru, Kelly Michael P, Chang Dong-Gune
Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea.
Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, Columbia University, New York, NY, USA.
Asian Spine J. 2024 Apr;18(2):287-300. doi: 10.31616/asj.2023.0408. Epub 2023 Dec 21.
The purpose of this systematic review and meta-analysis is to perform a systematic review and meta-analysis of previous studies on minimally invasive scoliosis surgery (MISS) in adolescents with idiopathic scoliosis (AIS). Some data on MISS in AIS compared with conventional open scoliosis surgery (COSS) are conflicting. A systematic literature search was conducted in Medline, Embase, and Cochrane Library, including studies reporting outcomes for MISS in AIS. The meta-analysis compared the operative, radiological, and clinical outcomes and complications between MISS and COSS in patients with AIS. Of the 208 records identified, 15 nonrandomized studies with 1,369 patients (reviews and case reports are excluded) were included in this systematic review and meta-analysis. The mean scale was 6.1, and eight of the 15 included studies showed satisfactory quality using the Newcastle-Ottawa scale. For operative outcomes, MISS had significant benefits in terms of estimated blood loss (standard mean difference [SMD], -1.87; 95% confidence interval [CI], -2.94 to -0.91) and hospitalization days (SMD, -2.99; 95% CI, -4.45 to -1.53) compared with COSS. However, COSS showed significantly favorable outcomes for operative times (SMD, 1.71; 95% CI, 0.92-2.51). No significant differences were observed in radiological outcomes, including Cobb's angle of the main curve and thoracic kyphosis. For clinical outcomes, MISS showed significant benefits on the visual analog scale score (SMD, -0.91; 95% CI, -1.36 to -0.47). The overall complication rates of MISS were similar to those of COSS (SMD, 0.96; 95% CI, 0.61-1.52). MISS using the posterior approach provides equivalent radiological and clinical outcomes and complication rates compared with COSS. Considering the lower estimated blood loss, shorter hospitalization days, and longer operative times in MISS, COSS is still the mainstay of surgical treatment in AIS; however, MISS using the posterior approach is also one of the surgical options of choice in the case of moderate AIS.
本系统评价和荟萃分析的目的是对既往关于青少年特发性脊柱侧凸（AIS）的微创脊柱侧凸手术（MISS）的研究进行系统评价和荟萃分析。AIS中MISS与传统开放性脊柱侧凸手术（COSS）相比的一些数据存在冲突。在Medline、Embase和Cochrane图书馆进行了系统的文献检索，包括报告AIS中MISS结果的研究。荟萃分析比较了AIS患者中MISS和COSS的手术、放射学和临床结果及并发症。在检索到的208条记录中，本系统评价和荟萃分析纳入了15项非随机研究，共1369例患者（排除综述和病例报告）。平均评分是6.1，15项纳入研究中有8项使用纽卡斯尔-渥太华量表显示质量令人满意。在手术结果方面，与COSS相比，MISS在估计失血量（标准化均数差[SMD]，-1.87；95%置信区间[CI]，-2.94至-0.91）和住院天数（SMD，-2.99；95%CI，-4.45至-`1.53）方面有显著优势。然而，COSS在手术时间方面显示出明显更好的结果（SMD，1.71；95%CI，0.92 - 2.51）。在放射学结果方面未观察到显著差异，包括主弯的Cobb角和胸椎后凸。在临床结果方面，MISS在视觉模拟量表评分上有显著优势（SMD，-0.91；95%CI，-1.36至-0.47）。MISS的总体并发症发生率与COSS相似（SMD，0.96；95%CI，0.61 - 1.52）。与COSS相比，采用后路入路的MISS在放射学和临床结果及并发症发生率方面相当。考虑到MISS中估计失血量较低、住院天数较短但手术时间较长，COSS仍然是AIS手术治疗的主要方法；然而，对于中度AIS病例，采用后路入路的MISS也是手术选择之一。
