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

Journal Article (Journal Article)

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° coronal 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°-51°, with 57% greater than 30° and 28.6% greater than 50°. The mean Cobb angle improved from 35.7° to 30°. A ceiling effect of 23° for curve correction was observed, regardless of preoperative curve severity. For the circumferential MIS group the preoperative Cobb range was 19°-62°, with 44% greater than 30° and 5% greater than 50°. The mean Cobb angle improved from 32° to 12°. A ceiling effect of 34° for curve correction was observed. For the hybrid group the preoperative Cobb range was 23°-82°, with 74% greater than 30° and 23% greater than 50°. The mean Cobb angle improved from 43° to 15°. A ceiling effect of 55° for 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.

Full Text

Duke Authors

Cited Authors

  • Wang, MY; Mummaneni, PV; Fu, K-MG; Anand, N; Okonkwo, DO; Kanter, AS; La Marca, F; Fessler, R; Uribe, J; Shaffrey, CI; Lafage, V; Haque, RM; Deviren, V; Mundis, GM; Minimally Invasive Surgery Section of the International Spine Study Group,

Published Date

  • May 2014

Published In

Volume / Issue

  • 36 / 5

Start / End Page

  • E12 -

PubMed ID

  • 24785477

Electronic International Standard Serial Number (EISSN)

  • 1092-0684

Digital Object Identifier (DOI)

  • 10.3171/2014.3.FOCUS1423


  • eng

Conference Location

  • United States