Reassessment System and Staged Surgical Strategy with Minimally Invasive Techniques for Treatment of Severe Adult Spinal Deformities

Abstract

We determined the feasibility of minimally invasive surgery for severe adult spinal deformities and proposed a reassessment system and staged minimally invasive surgical strategy. We treated 53 patients from June 2016 to August 2017 using a reassessment system and a staged surgical strategy with minimally invasive techniques for minimally invasive spinal deformity surgery, class III. Patients with scoliotic apex vertebrae above L1-L2 or spontaneous fusion of the facet joints were excluded. The reassessment system was applied. The first stage involved multisegmental lateral lumbar interbody fusion and anterior column realignment (ACR), and the second stage involved posterior minimally invasive surgery. The pre- and postoperative visual analog scale scores, Oswestry disability index, surgical data, and radiographic images were collected. The major and minor complications were recorded. All the patients were followed up for 11.5 months (range, 6-20). Lateral lumbar interbody fusion was performed in 168 segments, of which 113 had ACR. The average sagittal correction angle of each ACR segment was 15.6° ± 6.3° (range, 7°-28°). The correction rate of the Cobb angle for lumbar scoliosis after first stage was 55.4%, and the total correction rate was 75.6%. The lumbar lordosis-pelvic index mismatch was improved from-32.8° ± 14.9° to-2.5° ± 9.4°, reaching the sagittal matching state of the lumbar spine. A reassessment system and minimally invasive staged surgery for severe adult spinal deformity can achieve good clinical outcomes and deformity correction and might have the advantage of decreasing unnecessary iatrogenic injury.