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Published on: November 8, 2024
Circumferential Minimally Invasive Adult Spinal Deformity Surgery: A Systematic Review With Key Concepts and
Marcos Real1, Logan H Sigua1, Matthew R Allen1
1Department of Neurological Surgery, University of California, San Diego, California, USA.
Background:
While open techniques have historically dominated adult spinal deformity (ASD) surgery, minimally invasive (MIS) approaches have become ubiquitous in recent years due to advances in intraoperative guidance, spinal robotics, and planning software. Despite its promise, circumferential MIS (cMIS) for ASD remains uncertain in matching the appropriate correction of open surgery. This systematic review highlights core principles and techniques behind successful cMIS outcomes in ASD.
Methods:
A systematic search strategy was developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In November 2023, we queried PubMed, Embase, and Cochrane databases. We sought primary, peer-reviewed studies including ≥5 patients treated with cMIS for ASD, focusing on postoperative outcomes such as spinopelvic alignment and complication rates.
Results:
We identified 401 studies (2014-2023), of which 25 (24 retrospective, 1 prospective) met inclusion criteria, encompassing 2565 patients (weighted mean age 63.3 [21-85], 63.2% female among studies reporting sex) undergoing a mean of 7.1 operated spinal levels. cMIS demonstrated significant clinical improvement, including reductions in Visual Analog Scale and Oswestry Disability Index scores, and achieved postoperative spinopelvic alignment comparable to open approaches. Compared to open and hybrid techniques, cMIS reduced blood loss and complication rates but showed higher pseudarthrosis rates at long-term follow-up. Predictors of cMIS feasibility included DEXA T-scores, staged surgery consideration, and preoperative sagittal vertical axis >100 mm as a relative contraindication.
Conclusions:
CMIS for ASD is a safe and effective technique that achieves meaningful improvements in alignment and patient-reported outcomes while minimizing complications in appropriately selected patients.
