Clinical and radiological outcomes of staged minimally invasive surgery for adult degenerative scoliosis comparing with the conventional open surgery
10.3760/cma.j.issn.0253-2352.2019.20.003
- VernacularTitle: 分期微创与开放手术治疗成人退变性脊柱侧凸的疗效比较
- Author:
Wenjian WU
1
;
Yu LIANG
;
Peng CAO
;
Xinkai ZHANG
;
Tao ZHENG
;
Jianru QIU
Author Information
1. Department of Orthopaedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Midicine, Shanghai 200025, China
- Publication Type:Journal Article
- Keywords:
Adult;
Lumbar vertebrae;
Intervertebral disc degeneration;
Scoliosis;
Surgical procedures, minimally invasive;
Spinal fusion
- From:
Chinese Journal of Orthopaedics
2019;39(20):1239-1248
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical and radiological outcomes,and the complications of staged minimally invasive surgery for adult degenerative scoliosis, comparing with that of the conventional open surgery.
Methods:From Jun 2013 to Jun 2017, a total of 42 cases of degenerative scoliosis underwent surgical treatment. Among which, 23 cases underwent staged minimally invasive surgery(MIS group) and 19 cases underwent posterior open surgery(open group). The intra-operative bleeding, and operation time were recorded.The clinical outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for low back pain and leg pain.The radiological outcome was evaluated with Cobb angles and sagittal balance parameters (Sagittal Vertical Axis (SVA), Pelvic Incidence (PI)-Lumbar Lordosis (LL), Pelvic Tilt (PT)). The occurrence of complications was recorded.
Results:The baseline demographic features of both groups (gender, age, medical comorbidity, etc.) were similar.The mean follow-up period for both groups was more than 2 years.The intraoperative bleeding in the MIS group 405.7±144.8 ml was significantly lower than that in the open group (2 005.3±728.4 ml, t=10.31, P<0.001); The total operation time 414.3±63.0 min of MIS group was significantly longer than that of the open group (304.2±51.8 min, t=6.10, P<0.001), but the operating time of each stage was shorter than the open group. The VAS score for back pain and leg pain,the ODI scores were significantly improved after surgery for both group, there was no significant difference between the two groups, but the low back pain and function in MIS group were better than the open group. The parameters of the coronal and sagittal deformity were significantly improved in both groups, correction of coronal deformity in MIS groupwassignificantly superior to the open group (F=12.02, P=0.001), there was no significant difference in sagittal balance correction between the two groups. The overall complication rate (63.2%) was slightly higher in the open group than in the MIS group (34.8%) without significant difference(χ2=3.36, P=0.07). The incidence of major complications in the open group was significantly higher than that in the MIS group (P=0.014).
Conclusion:Staged minimally invasive surgery can significantly relieve the patient's pain, improve functionand the coronal and sagittal balance of the patient, the early clinical and radiological outcomes were comparable to the open surgery; Minimally invasive surgery may significantly reduce the amount of bleeding and major complications. Minimally invasive surgery is safe and effective for carefully selected patients with degenerative scoliosis.However, the long-term outcomes of minimally invasive surgery remains to be followed up.
