Dean Chou1, Gregory Mundis2, Michael Wang3, Kai-Ming Fu4, Christopher Shaffrey5, David Okonkwo6, Adam Kanter6, Robert Eastlack2, Stacie Nguyen7, Vedat Deviren8, Juan Uribe9, Richard Fessler10, Pierce Nunley11, Neel Anand12, Paul Park13, Praveen Mummaneni14. 1. Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA. Electronic address: dean.chou@ucsf.edu. 2. Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California, USA. 3. Department of Neurousrgery, University of Miami, Coral Gables, Florida, USA. 4. Department of Neurosurgery, Weill Cornell Medical College, New York, New York, USA. 5. Department of Neurosurgery, Duke University, Durham, North Carolina, USA. 6. Department of Neurosurgery, University of Pittsburgh, Pittsburg, Pennsylvania, USA. 7. Department of Orthopedic Surgery, San Diego Center for Spinal Disorders, La Jolla, California, USA. 8. Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA. 9. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA. 10. Department of Neurosurgery, Rush University, Chicago, Illinois, USA. 11. Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, Louisiana, USA. 12. Department of Orthopedic Surgery, Cedars Sinai Hospital, Los Angeles, California, USA. 13. Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA. 14. Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.
Abstract
OBJECTIVE: To compare circumferential minimally invasive (cMIS) versus open surgeries for mild-to-moderate adult spinal deformity (ASD) with regard to intensive care unit (ICU) and hospital lengths of stay (LOS). METHODS: A retrospective review of 2 multicenter ASD databases with 426 ASD (sagittal vertical axis <6 cm) surgery patients with 4 or more fusion levels and 2-year follow-up was conducted. ICU stay, LOS, and estimated blood loss (EBL) were compared between open and cMIS surgeries. RESULTS: Propensity matching resulted in 88 patients (44 cMIS, 44 open). cMIS were older (61 vs. 53 years, P = 0.005). Mean levels fused were 6.5 in cMIS and 7.1 in open (P = 0.368). Preoperative lordosis was higher in open than in cMIS (42.7° vs. 40.9°, P = 0.016), and preoperative visual analog score back pain was greater in open than in cMIS (7 vs. 6.2, P = 0.033). Preoperative and postoperative spinopelvic parameters and coronal Cobb angles were not different. EBL was 534 cc in cMIS and 1211 cc in open (P < 0.001). Transfusions were less in cMIS (27.3% vs. 70.5%, P < 0.001). ICU stay was 0.6 days for cMIS and 1.2 days for open (P = 0.009). Hospital LOS was 7.9 days for cMIS versus 9.6 for open (P = 0.804). CONCLUSIONS: For patients with mild-to-moderate ASD, cMIS surgery had a significantly lower EBL and shorter ICU stay. Major and minor complication rates were lower in cMIS patients than open patients. Overall LOS was shorter in cMIS patients, but did not reach statistical significance.
OBJECTIVE: To compare circumferential minimally invasive (cMIS) versus open surgeries for mild-to-moderate adult spinal deformity (ASD) with regard to intensive care unit (ICU) and hospital lengths of stay (LOS). METHODS: A retrospective review of 2 multicenter ASD databases with 426 ASD (sagittal vertical axis <6 cm) surgery patients with 4 or more fusion levels and 2-year follow-up was conducted. ICU stay, LOS, and estimated blood loss (EBL) were compared between open and cMIS surgeries. RESULTS: Propensity matching resulted in 88 patients (44 cMIS, 44 open). cMIS were older (61 vs. 53 years, P = 0.005). Mean levels fused were 6.5 in cMIS and 7.1 in open (P = 0.368). Preoperative lordosis was higher in open than in cMIS (42.7° vs. 40.9°, P = 0.016), and preoperative visual analog score back pain was greater in open than in cMIS (7 vs. 6.2, P = 0.033). Preoperative and postoperative spinopelvic parameters and coronal Cobb angles were not different. EBL was 534 cc in cMIS and 1211 cc in open (P < 0.001). Transfusions were less in cMIS (27.3% vs. 70.5%, P < 0.001). ICU stay was 0.6 days for cMIS and 1.2 days for open (P = 0.009). Hospital LOS was 7.9 days for cMIS versus 9.6 for open (P = 0.804). CONCLUSIONS: For patients with mild-to-moderate ASD, cMIS surgery had a significantly lower EBL and shorter ICU stay. Major and minor complication rates were lower in cMIS patients than open patients. Overall LOS was shorter in cMIS patients, but did not reach statistical significance.
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