Khoi D Than1, Paul Park2, Stacie Tran3, Gregory M Mundis4, Kai-Ming Fu5, Juan S Uribe6, David O Okonkwo7, Pierce D Nunley8, Richard G Fessler9, Robert K Eastlack4, Adam Kanter7, Neel Anand10, Frank LaMarca11, Peter G Passias12, Praveen V Mummaneni13. 1. Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA. Electronic address: thank@ohsu.edu. 2. Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA. 3. San Diego Center for Spinal Disorders, La Jolla, California, USA. 4. Division of Orthopaedic Surgery, Scripps Clinic Medical Group, La Jolla, California, USA. 5. Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA. 6. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA. 7. Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. 8. Department of Neurosurgery, Spine Institute of Louisiana, Shreveport, Louisiana, USA. 9. Department of Neurosurgery, Rush Medical College, Chicago, Illinois, USA. 10. Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California, USA. 11. Department of Neurological Surgery, Henry Ford Hospital, Detroit, Michigan, USA. 12. Department of Orthopedic Surgery, New York Spine Institute, New York, New York, USA. 13. Department of Neurological Surgery, University of California, San Francisco, California, USA.
Abstract
BACKGROUND: Spinal deformity surgery is often invasive and lengthy. Staging surgery over separate operative days may reduce complications. Staging is often used in minimally invasive treatment of adult spinal deformity (ASD). OBJECTIVE: To investigate the impact of staging on complication rates between hybrid (HYB; minimally invasive interbody with open posterior screw and rod fixation) and circumferential minimally invasive surgery (cMIS; minimally invasive interbody and screw/rod placement) procedures in patients with ASD. METHODS: A multicenter database of patients with ASD was reviewed. Patients who underwent staging (at least 3 levels) and 2 years of follow-up were analyzed. A total of 99 patients underwent staging: 53 cMIS and 46 HYB surgeries. Propensity matching for levels fused resulted in 19 patients in each group. Intra- and perioperative complications were assessed. RESULTS: Three HYB but no cMIS intraoperative complications occurred. More HYB patients had perioperative complications than cMIS patients. Neurologic complications were more frequent in HYB versus cMIS. Other complications did not differ significantly. Thirty-day reoperations were higher with cMIS than HYB, but there was no difference in reoperation rate at long-term follow-up. cMIS patients had greater improvement in the Oswestry Disability Index. There was no difference in complications between staged versus unstaged cMIS surgeries. CONCLUSIONS: cMIS staged surgeries appear safer than HYB staged surgeries, and equally safe to cMIS unstaged surgeries. Perioperative complications were significantly higher for HYB staged surgeries. HYB surgeries may have better results when performed in a single setting, whereas cMIS surgeries can be performed in 1 or 2 stages depending on surgeon preference.
BACKGROUND:Spinal deformity surgery is often invasive and lengthy. Staging surgery over separate operative days may reduce complications. Staging is often used in minimally invasive treatment of adult spinal deformity (ASD). OBJECTIVE: To investigate the impact of staging on complication rates between hybrid (HYB; minimally invasive interbody with open posterior screw and rod fixation) and circumferential minimally invasive surgery (cMIS; minimally invasive interbody and screw/rod placement) procedures in patients with ASD. METHODS: A multicenter database of patients with ASD was reviewed. Patients who underwent staging (at least 3 levels) and 2 years of follow-up were analyzed. A total of 99 patients underwent staging: 53 cMIS and 46 HYB surgeries. Propensity matching for levels fused resulted in 19 patients in each group. Intra- and perioperative complications were assessed. RESULTS: Three HYB but no cMIS intraoperative complications occurred. More HYB patients had perioperative complications than cMIS patients. Neurologic complications were more frequent in HYB versus cMIS. Other complications did not differ significantly. Thirty-day reoperations were higher with cMIS than HYB, but there was no difference in reoperation rate at long-term follow-up. cMIS patients had greater improvement in the Oswestry Disability Index. There was no difference in complications between staged versus unstaged cMIS surgeries. CONCLUSIONS: cMIS staged surgeries appear safer than HYB staged surgeries, and equally safe to cMIS unstaged surgeries. Perioperative complications were significantly higher for HYB staged surgeries. HYB surgeries may have better results when performed in a single setting, whereas cMIS surgeries can be performed in 1 or 2 stages depending on surgeon preference.
Authors: Andrew S Chung; Alexander Ballatori; Brandon Ortega; Elliot Min; Blake Formanek; John Liu; Patrick Hsieh; Raymond Hah; Jeffrey C Wang; Zorica Buser Journal: Global Spine J Date: 2020-09-25