Minimally Invasive Spinal Surgery for Adult Spinal Deformity

Abstract

The purpose of this review is to present the current techniques and outcomes of adult spine deformity (ASD) surgery using the minimally invasive spine surgery (MISS) approach. We performed a systemic search of PubMed for literature published through January 2018 with the following terms: "minimally invasive spine surgery," "adult spinal deformity," and "degenerative scoliosis." Of the 138 items that were found through this search, 57 English-language articles were selected for full-text review. According to the severity of the deformity and the symptoms, various types of MISS have been utilized, such as MISS decompression, circumferential MISS, and hybrid surgery. With proper indications, the MISS approach achieved satisfactory clinical and radiological outcomes for ASD, with reduced complication rates. Future studies should aim to define clear indications for the application of various surgical options.

Keywords: Adult spinal deformity; Degenerative scoliosis; Minimally invasive spine surgery.

Fig. 1.

Case presentation of circumferential minimally invasive surgery for degenerative scoliosis. Preoperative anteriorposterior (A) and lateral (B) radiographs shows coronal plane deformity on lumbar spine. Lateral lumbar interbody fusion at the L1–2, L2–3, L3–4, and L4–5 followed by percutaneous pedicle screw instrumentation successfully restored coronal balance as well as the lordotic curvature of the lumbar spine (C, D).

Fig. 2.

Case presentation of hybrid surgery for degenerative kyphoscoliosis. Preoperative anteriorposterior (A) and lateral (B) radiographs shows rigid deformity on both coronal and sagittal plane. Lateral lumbar interbody fusion from L1 to L4 and anterior lumbar interbody fusion from L4 to S1 was performed to restore anterior disc height. Additionally, open posterior segmental instrumentation from T10 to iliac fixation with multilevel grade 2 osteotomies was done to release posterior column mobility and further correction. Postperative anteriorposterior (C) and lateral (D) radiographs shows well balanced coronal and sagittal curvature.