The Current State of Minimally Invasive Approaches to Adult Spinal Deformity.

Abstract

Minimally invasive approaches to adult spinal deformity (ASD) surgery have seen a large increase in popularity over the last decade, largely because these techniques are viewed as a potential improvement to the lengthy recovery and high complication rates observed after traditional open surgery for this pathology. The purpose of this review is to present a summary of the latest minimally invasive techniques used in adult spinal deformity surgery, examine whether MIS surgery can accomplish the goals of ASD surgery, and investigate whether MIS surgery is safer than traditional approaches. While minimally invasive approaches have been able to achieve similar patient-reported outcomes as open approaches, they are associated with their own unique complications. Furthermore, they are limited in their ability to correct severe sagittal imbalance. Emerging techniques, such as anterior column realignment and mini-open posterior column osteotomy, have been developed to address these limitations. The minimally invasive spinal deformity surgery algorithm (MISDEF) can help guide surgeons on which approaches may be appropriate for a particular case. To maximize the benefits of a minimally invasive approach without compromising the goals of ASD surgery, surgeons must be selective in choosing which cases are amenable to an MIS approach. Leading experts continue to develop algorithms to guide surgical decision-making. As we learn to better define our indications, understand treatment goals, and refine our techniques, MIS approaches will likely play an even larger role in a comprehensive ASD treatment strategy.