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. 2018 Dec;8(8):827-833.
doi: 10.1177/2192568218775069. Epub 2018 May 10.

Treatment of the Fractional Curve of Adult Scoliosis With Circumferential Minimally Invasive Surgery Versus Traditional, Open Surgery: An Analysis of Surgical Outcomes

Dean Chou  1 , Praveen Mummaneni  1 , Neel Anand  2 , Pierce Nunley  3 , Frank La Marca  4 , Kai-Ming Fu  5 , Richard Fessler  6 , Paul Park  4 , Michael Wang  7 , Khoi Than  8 , Stacie Nguyen  9 , Juan Uribe  10 , Joseph Zavatsky  11 , Vedat Deviren  1 , Adam Kanter  12 , David Okonkwo  12 , Robert Eastlack  13 , Gregory Mundis  13 ; International Spine Study Group
Affiliations

Treatment of the Fractional Curve of Adult Scoliosis With Circumferential Minimally Invasive Surgery Versus Traditional, Open Surgery: An Analysis of Surgical Outcomes

Dean Chou et al. Global Spine J. 2018 Dec.

Abstract

Study design: Retrospective, multicenter review of adult scoliosis patients with minimum 2-year follow-up.

Objective: Because the fractional curve (FC) of adult scoliosis can cause radiculopathy, we evaluated patients treated with either circumferential minimally invasive surgery (cMIS) or open surgery.

Methods: A multicenter retrospective adult deformity review was performed. Patients included: age >18 years with FC >10°, ≥3 levels of instrumentation, 2-year follow-up, and one of the following: coronal Cobb angle (CCA) > 20°, pelvic incidence and lumbar lordosis (PI-LL) > 10°, pelvic tilt (PT) > 20°, and sagittal vertical axis (SVA) > 5 cm.

Results: The FC was treated in 118 patients, 79 open and 39 cMIS. The FCs had similar coronal Cobb angles preoperative (17° cMIS, 19.6° open) and postoperative (7° cMIS, 8.1° open), but open had more levels treated (12.1 vs 5.7). cMIS patients had greater reduction in VAS leg (6.4 to 1.8) than open (4.3 to 2.5). With propensity matching 40 patients for levels treated (cMIS: 6.6 levels, N = 20; open: 7.3 levels, N = 20), both groups had similar FC correction (18° in both preoperative, 6.9° in cMIS and 8.5° postoperative). Open had more posterior decompressions (80% vs 22.2%, P < .001). Both groups had similar preoperative (Visual Analogue Scale [VAS] leg 6.1 cMIS and 5.4 open) and postoperative (VAS leg 1.6 cMIS and 3.1 open) leg pain. All cMIS patients had interbody grafts; 35% of open did. There was no difference in change of primary CCA, PI-LL, LL, Oswestry Disability Index, or VAS Back.

Conclusion: Patients' FCs treated with cMIS had comparable reduction of leg pain compared with those treated with open surgery, despite significantly fewer cMIS patients undergoing direct decompression.

Keywords: MIS; deformity; fractional curve; laminectomy; lumbar; lumbar interbody fusion; minimally invasive; radiculopathy; scoliosis.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(A, B). Preoperative and postoperative images of a patient with adult scoliosis and radiculopathy being treated for the fractional curve only via anterior mini-open lumbar interbody fusion and percutaneous screw fixation without decompression.
Figure 2.
Figure 2.
(A) Coronal computed tomography reconstruction showing coronal tilt of vertebra in the fractional curve resulting in “B,” foraminal, up-down stenosis (see arrow).
Figure 3.
Figure 3.
(A, B) Preoperative and postoperative images of the same patient in Figure 2, demonstrating anterior-only treatment of the fractional curve with minimally invasive lateral interbody fusion with anterior fixation.
See this image and copyright information in PMC

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