Minimally Invasive Surgery for Mild-to-Moderate Adult Spinal Deformities: Impact on Intensive Care Unit and Hospital Stay

World Neurosurg. 2019 Jul;127:e649-e655. doi: 10.1016/j.wneu.2019.03.237. Epub 2019 Apr 1.

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.

Keywords: Deformity; Length of stay; MIS; Minimally invasive; Scoliosis; Spinal deformity.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Female
  • Humans
  • Intensive Care Units / trends*
  • Length of Stay / trends*
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods*
  • Minimally Invasive Surgical Procedures / trends*
  • Prospective Studies
  • Retrospective Studies
  • Spinal Diseases / diagnostic imaging*
  • Spinal Diseases / surgery*