Reoperation rates in minimally invasive, hybrid and open surgical treatment for adult spinal deformity with minimum 2-year follow-up

D Kojo Hamilton; Adam S Kanter; Bryan D Bolinger; Gregory M Mundis Jr; Stacie Nguyen; Praveen V Mummaneni; Neel Anand; Richard G Fessler; Peter G Passias; Paul Park; Frank La Marca; Juan S Uribe; Michael Y Wang; Behrooz A Akbarnia; Christopher I Shaffrey; David O Okonkwo; International Spine Study Group (ISSG)

doi:10.1007/s00586-016-4443-2

Reoperation rates in minimally invasive, hybrid and open surgical treatment for adult spinal deformity with minimum 2-year follow-up

Eur Spine J. 2016 Aug;25(8):2605-11. doi: 10.1007/s00586-016-4443-2. Epub 2016 Feb 24.

Authors

D Kojo Hamilton¹, Adam S Kanter², Bryan D Bolinger³, Gregory M Mundis Jr⁴, Stacie Nguyen⁴, Praveen V Mummaneni⁵, Neel Anand⁶, Richard G Fessler⁷, Peter G Passias⁸, Paul Park⁹, Frank La Marca⁹, Juan S Uribe¹⁰, Michael Y Wang¹¹, Behrooz A Akbarnia⁴, Christopher I Shaffrey¹², David O Okonkwo²; International Spine Study Group (ISSG)

Affiliations

¹ Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA, 15213, USA. dkojoh@gmail.com.
² Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA, 15213, USA.
³ Geisinger Neurosurgery, Geisinger Medical Center, Danville, PA, USA.
⁴ San Diego Center for Spinal Disorders, La Jolla, CA, USA.
⁵ Department of Neurosurgery, University of California San Francisco Medical Center, San Francisco, CA, USA.
⁶ Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
⁷ Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
⁸ Department of Orthopedic Surgery, NYU Hospital for Joint Disease, New York, NY, USA.
⁹ Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA.
¹⁰ Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA.
¹¹ Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA.
¹² Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA.

PMID: 26909764
DOI: 10.1007/s00586-016-4443-2

Abstract

Introduction: Minimally invasive surgical (MIS) techniques are gaining popularity in the treatment of adult spinal deformity (ASD). The premise is that MIS techniques will lead to equivalent outcomes and a reduction in perioperative complications when compared with open techniques. Potential issues with MIS techniques are a limited capacity to correct lumbar lordosis, unknown long-term efficacy, and the potential need for revision surgery. This study compares reoperation rates and reasons for reoperation following MIS, hybrid, and open surgery for ASD through multicenter database analysis.

Methods: We retrospectively analyzed a prospective multicenter ASD database comparing open and MIS correction techniques. Inclusion criteria were: age > 18 years with minimum 20° coronal lumbar Cobb angle, a minimum of three levels fused, and minimum 2-year follow-up. Patients were propensity matched for preoperative sagittal vertebral axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), and number of levels fused. We included 189 patients from three propensity-matched subgroups of 63 patients each: (1) MIS: lateral or transforaminal lumbar interbody fusion (LIF) and percutaneous pedicle instrumentation, (2) Hybrid: MIS LIF with open posterior segmental fixation (PSF), and (3) OPEN: open posterior fixation ± osteotomies.

Results: With propensity matching, there were significant differences between groups in pre-op SVA or PI-LL (p > 0.05). The MIS group had significantly fewer levels fused (5.4) (0-14) than the OPEN group (7.4) (p = 0.002) (0-17). The rate of revision surgery was significantly different between the groups with a higher rate of revision (27 %) amongst the HYB group versus MIS = 11.1 %, and OPEN = 12.0 %. The most common reason for reoperation in the OPEN and HYB groups was a postoperative neurological deficit (7.9 and 11.1 %), respectively. The most common reason for reoperation in the MIS group was pseudoarthrosis (7.9 %).

Conclusions: Reoperation rates were not statistically different among the MIS, and OPEN surgical groups, but differed significantly on multivariate analysis with HYB group. The incidence of reoperations was twice as high in the Hybrid group compared to OPEN and MIS.

Keywords: Adult spinal deformity; Hybrid; Minimally invasive; Revision.

MeSH terms

Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Humans
Male
Middle Aged
Minimally Invasive Surgical Procedures* / adverse effects
Minimally Invasive Surgical Procedures* / methods
Minimally Invasive Surgical Procedures* / statistics & numerical data
Reoperation / statistics & numerical data*
Spinal Curvatures / surgery*
Spinal Fusion* / adverse effects
Spinal Fusion* / methods
Spinal Fusion* / statistics & numerical data
Young Adult