TY - JOUR
T1 - Minimally invasive surgery in patients with adolescent idiopathic scoliosis
AU - Sarwahi, Vishal
AU - Horn, Jonathan J.
AU - Kulkarni, Preethi M.
AU - Wollowick, Adam L.
AU - Lo, Yungtai
AU - Gambassi, Melanie
AU - Amaral, Terry D.
N1 - Publisher Copyright:
© 2014 Wolters Kluwer Health, Inc.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Study Design: This is a retrospective controlled study. Objective: To compare the safety and efficacy of minimally invasive surgery (MIS) for the surgical management of adolescent idiopathic scoliosis (AIS) to the standard open posterior approach (PSF). Summary of Background Data: MIS approaches offer the potential to reduce soft-tissue trauma, intraoperative blood loss, and surgical-site infection. Thus far, MIS has been successfully utilized for the surgical correction of multilevel spine pathology in adults. It is not yet known if these results can be replicated in the surgical management of AIS. Materials and Methods: Seven MIS patients were compared with 15 PSF patients using minimum 2-year follow-up data. Parameters studied included preoperative patient and deformity characteristics, perioperative details, extent of deformity correction, and complications. Data were compared using Mann-Whitney tests for continuous variables and Fisher exact tests for categorical variables. Results: The MIS and PSF groups were similar for all preoperative characteristics collected (P>0.05). MIS patients had fewer fixation points (P=0.015), but a longer median operative time (P=0.011). There was no significant difference in estimated blood loss (EBL) (P=0.051), EBL/fixation point (P=0.204), or amount of fluids administered (P=0.888). Postoperative recovery did not differ between the 2 groups in number of intensive care unit days (P=0.362), length of hospital stay (P=0.472), time to mobilization (P=1.00), Visual Analogue Scale pain scores (P=0.698), or patient-controlled analgesia (P=1.00). The MIS technique had similar deformity correction, screw placement accuracy, and fusion status when compared with the PSF group. MIS patients had lower blood transfusion rate (P=0.02), shorter fusion (P=0.046) and fewer pedicle screws (P=0.015). Conclusions: The short-term advantages seen in MIS for adult scoliosis were not as obvious in our series. We found similar deformity correction and adequate fusion, however shortcomings related to learning curve, and instrumentation persist. MIS surgery is an innovative treatment for AIS that is technically feasible with significantly lower transfusion rate, shorter fusion lenghts and lesser pedicle screw fixation. Despite these advanatges, its role in AIS is currently difficut to define.
AB - Study Design: This is a retrospective controlled study. Objective: To compare the safety and efficacy of minimally invasive surgery (MIS) for the surgical management of adolescent idiopathic scoliosis (AIS) to the standard open posterior approach (PSF). Summary of Background Data: MIS approaches offer the potential to reduce soft-tissue trauma, intraoperative blood loss, and surgical-site infection. Thus far, MIS has been successfully utilized for the surgical correction of multilevel spine pathology in adults. It is not yet known if these results can be replicated in the surgical management of AIS. Materials and Methods: Seven MIS patients were compared with 15 PSF patients using minimum 2-year follow-up data. Parameters studied included preoperative patient and deformity characteristics, perioperative details, extent of deformity correction, and complications. Data were compared using Mann-Whitney tests for continuous variables and Fisher exact tests for categorical variables. Results: The MIS and PSF groups were similar for all preoperative characteristics collected (P>0.05). MIS patients had fewer fixation points (P=0.015), but a longer median operative time (P=0.011). There was no significant difference in estimated blood loss (EBL) (P=0.051), EBL/fixation point (P=0.204), or amount of fluids administered (P=0.888). Postoperative recovery did not differ between the 2 groups in number of intensive care unit days (P=0.362), length of hospital stay (P=0.472), time to mobilization (P=1.00), Visual Analogue Scale pain scores (P=0.698), or patient-controlled analgesia (P=1.00). The MIS technique had similar deformity correction, screw placement accuracy, and fusion status when compared with the PSF group. MIS patients had lower blood transfusion rate (P=0.02), shorter fusion (P=0.046) and fewer pedicle screws (P=0.015). Conclusions: The short-term advantages seen in MIS for adult scoliosis were not as obvious in our series. We found similar deformity correction and adequate fusion, however shortcomings related to learning curve, and instrumentation persist. MIS surgery is an innovative treatment for AIS that is technically feasible with significantly lower transfusion rate, shorter fusion lenghts and lesser pedicle screw fixation. Despite these advanatges, its role in AIS is currently difficut to define.
KW - adolescent idiopathic scoliosis
KW - minimally invasive surgery
KW - pedicle screw instrumentation
KW - posterior spinal fusion
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U2 - 10.1097/BSD.0000000000000106
DO - 10.1097/BSD.0000000000000106
M3 - Article
C2 - 24852384
AN - SCOPUS:84900896915
SN - 2380-0186
VL - 29
SP - 331
EP - 340
JO - Clinical spine surgery
JF - Clinical spine surgery
IS - 8
ER -