View Full Version : Minimally invasive surgery - 2-5 year follow-up - Anand et al.

06-01-2013, 09:19 PM
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

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.

06-02-2013, 02:25 AM
Ahhh....a few years has passed.

67 of 71 did PLIF’s so this is an advantage only for anterior candidates. Am I correct in saying this?


06-02-2013, 02:41 AM
This was 3 years ago.....



06-02-2013, 06:22 AM
to me, it sounds as if Anand is just as much in favor of MI approach
as he was 3+ years ago when i flew out to see him for a consult...

someone said he has changed and still believes in MI for lumbar fusion,
but not as universally as he first did...
i do not get that sense from reading this

jess...and Sparky

06-02-2013, 12:10 PM
Some thoughts....

It seems that the advantage lies in avoiding large “lumbar” anterior incisions from the front.

The adhesion (scar tissue) complication question will take many many years to gather the data and you have to track and keep a eye on these patients if they move.

They state that they reviewed 71 scoliosis patients that had 2 or more levels. It would be nice to know fusion lengths since 2 levels for scoliosis surgery seems like such a small number for scoliosis. Did 70 have 2 levels, and the last had 3? They did have only 1 PJK which doesn’t seem too bad if they are going short.

I would bet that they throw out all that portal hardware after each surgery.....It looks VERY expensive to me....(Knock your socks off pricing structure)

DLIF video


06-02-2013, 12:14 PM
i only spoke to two of Anand's patients on the phone..
both were women over age 60...both were happy with their
results at the time...both had lumbar fusions and i do remember
one said she had a long fusion, from T4-sacrum...
i do not remember where the other patient's fusion started, but
she was also fused to sacrum.
i am surprised that 14 had some kind of problem following surgery...
at the time i spoke to Anand, he mentioned two patients who had
leg problems that required further tx.

Dr Anand has video of his own procedures on his web pages...i seem
to remember animation.