Less invasive surgery for treating adult spinal deformities: Ceiling effects for deformity correction with 3 different techniques

摘要

Object: Minimally invasive surgery (MIS) options for the treatment of adult spinal deformity (ASD) have advanced significantly over the past decade. However, a wide array of options have been described as being MIS or less invasive. In this study the authors investigated a multiinstitutional cohort of patients with ASD who were treated with less invasive methods to determine the extent of deformity correction achieved. Methods: This study was a retrospective review of multicenter prospectively collected data in 85 consecutive patients with ASD undergoing MIS surgery. Inclusion criteria were as follows: age older than 45 years; minimum 20]oronal lumbar Cobb angle; and 1 year of follow-up. Procedures were classified as follows: 1) stand-alone (n = 7); 2) circumferential MIS (n = 43); or 3) hybrid (n = 35). Results: An average of 4.2 discs (range 3-7) were fused, with a mean follow-up duration of 26.1 months in this study. For the stand-alone group the preoperative Cobb range was 22?齱ith 57% greater than 30[nd 28.6% greater than 50齌he mean Cobb angle improved from 35.7no 30鼳 ceiling effect of 23`or curve correction was observed, regardless of preoperative curve severity. For the circumferential MIS group the preoperative Cobb range was 19?齱ith 44% greater than 30[nd 5% greater than 50齌he mean Cobb angle improved from 32no 12鼳 ceiling effect of 34`or curve correction was observed. For the hybrid group the preoperative Cobb range was 23?齱ith 74% greater than 30[nd 23% greater than 50齌he mean Cobb angle improved from 43no 15鼳 ceiling effect of 55`or curve correction was observed. Conclusions: Specific procedures for treating ASD have particular limitations for scoliotic curve correction. Less invasive techniques were associated with a reduced ability to straighten the spine, particularly with advanced curves. These data can guide preoperative technique selection when treating patients with ASD.