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Minimally Invasive Versus Standard Surgery in Idiopathic Scoliosis Patients: A Comparative Study
Vishal Sarwahi1, Jesse M Galina1, Sayyida Hasan1
1Department of Pediatric Orthopaedics, Cohen Children's Medical Center, Northwell Health System, New Hyde Park, NY.
Study Design:
Retrospective review of prospective case-control study.
Objective:
To compare minimally invasive scoliosis surgery (MIS) and posterior spinal fusion (PSF) in a large group of patients.
Summary Of Background Data:
MIS, has been shown to have benefits over standard PSF in adolescent idiopathic scoliosis (AIS).
Methods:
Radiographic, clinical, and operative review of a multi-institutional prospective database from 2013 to 2018. MIS patients with minimum 2-year XR follow up were compared with open PSF technique patients.
Results:
Four hundred eighty five patients were included; 192 MIS and 293 PSF. Preoperative Cobb (P = 0.231) and kyphosis were similar (P = 0.501). Cobb correction was comparable (P = 0.46), however percent improvement in thoracic kyphosis was significantly higher in MIS (P < 0.001). MIS had significantly lower blood loss (P < 0.001), transfusions (P < 0.001), fixation points (P < 0.001), opioid consumption (P = 0.001), and hospital stay (P < 0.001). Operative time was shorter (P = 0.001) and 30-day complications rate was similar (P = 0.81).
Conclusion:
This is the largest study comparing the surgical outcomes of MIS and PSF. MIS patients benefit from increased kyphosis, fewer transfusion, lower opioid consumption, and shorter hospital stay with similar Cobb correction. Increased postoperative kyphosis is likely from muscle sparing dissection in MIS.Level of Evidence: 3.
Insights
Minimally invasive scoliosis surgery (MIS) offers advantages over posterior spinal fusion (PSF), including improved kyphosis and reduced complications. This large study confirms MIS benefits for adolescent idiopathic scoliosis patients.
Area of Science:
- Spine surgery
- Orthopedics
- Surgical outcomes
Background:
- Minimally invasive surgery (MIS) shows potential benefits compared to traditional posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).
- Previous studies suggest advantages for MIS, but large-scale comparisons are needed.
Purpose of the Study:
- To compare the surgical outcomes of MIS and PSF in a substantial patient cohort.
- Evaluate differences in radiographic correction, blood loss, opioid consumption, and hospital stay between the two surgical techniques.
Main Methods:
- Retrospective review of a multi-institutional prospective database (2013-2018).
- Comparison of 192 patients undergoing MIS with 293 patients undergoing open PSF.
- Minimum 2-year radiographic follow-up for MIS patients.
Main Results:
- While Cobb angle correction was similar, MIS demonstrated a significantly higher percent improvement in thoracic kyphosis (P < 0.001).
- MIS group experienced significantly lower blood loss, transfusion rates, fixation points, opioid consumption, and hospital stay (all P < 0.001).
- Operative time was shorter for MIS (P = 0.001), with similar 30-day complication rates (P = 0.81).
Conclusions:
- This study, the largest of its kind, highlights significant benefits of MIS over PSF for scoliosis treatment.
- MIS leads to improved kyphosis, reduced transfusions, lower opioid use, and shorter hospital stays with comparable spinal alignment correction.
- Muscle-sparing dissection in MIS is likely responsible for the increased postoperative kyphosis.
