New paper by Anand and pals on minimally invasive surgery
Long Term 2 to 5 year Clinical and Functional Outcomes of Minimally Invasive Surgery (MIS) for Adult Scoliosis
Anand, Neel; Baron, Eli M.; Khandehroo, Babak; Kahwaty, Sheila
Spine., POST ACCEPTANCE, 23 May 2013
Abstract:
Study Design. A retrospective study
Summary of Background. Traditional surgical approaches for Adult Scoliosis are associated with significant blood loss and morbidity, in a population that is often elderly with multiple medical comorbidities. MIS represents a newer method of achieving similar long-term outcomes but considerably lower morbidity and complication rates.
Objective. We assess MIS technique's clinical and functional outcomes over a 2-5 year period.
Methods. We reviewed 71patients who underwent MIS correction of spinal deformity with fusion of 2 or more levels including: Degenerative scoliosis(54), Idiopathic scoliosis(11) and Iatrogenic scoliosis(6). All underwent a combination of 3 MIS techniques: DLIF(66), AxiaLIF(34) and posterior instrumentation(67). 36pts were staged with DLIF done first followed by the posterior instrumentation and fusion including AxiaLIF done three days later.
Results. Mean age was 64yrs(20-84). Mean Follow-up was 39mths(24-60). Patients with one-stage same day surgery had a mean blood loss of412ml and a mean surgical time of 291min. Patients with two-stage surgery had a mean blood loss of 314ml and surgical time of 183min for DLIF and 357ml and 243min respectively for posterior instrumentation and AxiaLIF. Mean hospital stay was 7.6days(2-26). The mean Pre-op Cobb angle was 24.7(8.3-65), which corrected to 9.5(0.6-28.8). The pre-op Coronal balance was 25.5mm,which corrected to 11mm. The pre-op sagittal balance was 31.7mm and corrected to 10.7mm. The mean pre-op lumbar AVT was 24mm and corrected to 12mm. 14 patients had adverse events requiring intervention: 4 Pseudoarthrosis, 4 persistent stenosis, 1 osteomyelitis, 1 adjacent segment discitis, 1 late wound infection, 1PJK, 1 screw prominence, 1 idiopathic cerebellar hemorrhage, and 2 wound dehiscence.
Conclusions. A combination of 3 Novel MIS techniques allows comparable correction of Adult Spinal Deformity, with low pseudarthrosis rates, significantly improved functional outcomes, excellent clinical and radiological improvement, but considerably lowers morbidity and complication rates at early and long term follow-up.
(C) 2013 Lippincott Williams & Wilkins, Inc.
Anand, Neel; Baron, Eli M.; Khandehroo, Babak; Kahwaty, Sheila
Spine., POST ACCEPTANCE, 23 May 2013
Abstract:
Study Design. A retrospective study
Summary of Background. Traditional surgical approaches for Adult Scoliosis are associated with significant blood loss and morbidity, in a population that is often elderly with multiple medical comorbidities. MIS represents a newer method of achieving similar long-term outcomes but considerably lower morbidity and complication rates.
Objective. We assess MIS technique's clinical and functional outcomes over a 2-5 year period.
Methods. We reviewed 71patients who underwent MIS correction of spinal deformity with fusion of 2 or more levels including: Degenerative scoliosis(54), Idiopathic scoliosis(11) and Iatrogenic scoliosis(6). All underwent a combination of 3 MIS techniques: DLIF(66), AxiaLIF(34) and posterior instrumentation(67). 36pts were staged with DLIF done first followed by the posterior instrumentation and fusion including AxiaLIF done three days later.
Results. Mean age was 64yrs(20-84). Mean Follow-up was 39mths(24-60). Patients with one-stage same day surgery had a mean blood loss of412ml and a mean surgical time of 291min. Patients with two-stage surgery had a mean blood loss of 314ml and surgical time of 183min for DLIF and 357ml and 243min respectively for posterior instrumentation and AxiaLIF. Mean hospital stay was 7.6days(2-26). The mean Pre-op Cobb angle was 24.7(8.3-65), which corrected to 9.5(0.6-28.8). The pre-op Coronal balance was 25.5mm,which corrected to 11mm. The pre-op sagittal balance was 31.7mm and corrected to 10.7mm. The mean pre-op lumbar AVT was 24mm and corrected to 12mm. 14 patients had adverse events requiring intervention: 4 Pseudoarthrosis, 4 persistent stenosis, 1 osteomyelitis, 1 adjacent segment discitis, 1 late wound infection, 1PJK, 1 screw prominence, 1 idiopathic cerebellar hemorrhage, and 2 wound dehiscence.
Conclusions. A combination of 3 Novel MIS techniques allows comparable correction of Adult Spinal Deformity, with low pseudarthrosis rates, significantly improved functional outcomes, excellent clinical and radiological improvement, but considerably lowers morbidity and complication rates at early and long term follow-up.
(C) 2013 Lippincott Williams & Wilkins, Inc.
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