Minimal invasive posterior correction of Lenke 5C idiopathic scoliosis: comparative analysis of minimal invasive vs. open surgery

摘要

Introduction Surgical management of adolescent idiopathic scoliosis in spite of usually favourable outcomes is still a major operation. Therefore, efforts are being undertaken to minimalize the procedure, reduce the surgical trauma and postoperative convalescence. The study was designed to compare posterior minimal invasive surgery using navigation based on intraopera-tive 3D imaging and standard open instrumented fusion in Lenke 5C idiopathic scoliosis treatment. Materials and methods From eight patients with Lenke 5C curves planned for posterior correction and instrumented fusion, four were treated with minimally invasive and four had open procedure. Operation length, estimated blood loss, number of fusion levels, days of opioid intake, length of hospital stay and radiation doses required were noted. Radiographic assessment of spinal curvatures was performed (magnitude, flexibility, sagittal alignment). The comparison of the data was done between open and minimally invasive treated patients. Results In minimally invasive surgery group, the operations were longer on average 285 min±47.5 than in the open surgery group, 242.5 min±44.5 (p = 0.371) and resulted in slightly inferior coronal curve correction by 68.25 ± 6.2 vs. 78.25 ± 8.8, respectively (p = 0.072). We observed a clear reduction of intraoperative blood loss in minimally invasive patients (mean 138.75 ±50 vs. 450± 106 ml, p = 0.016), shorter hospital stay, average 3.75 vs. 7 days (p = 0.043) and lower opioid requirements postoperatively-2 vs. 3.25 days (p = 0.015). Conclusions The minimally invasive approach to idiopathic scoliosis treatment is a very promising technique to limit the extent of surgery maintaining the same goals as in the open method. It allows for lower blood loss, less requirement for opioids and a shorter hospital stay.