Durability in symptomatic and radiographic outcomes after standalone anterolateral minimally invasive surgery for adult spinal deformity

IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY
Ayesha Akbar Waheed , Alp Ozpinar , Nallammai Muthiah , James H. Mooney , Harry M. Mushlin , Daipayan Guha , Thomas J. Buell , Hansen Deng , Nima Alan , Marc Peretti BS , Nitin Agarwal MD , D.Kojo Hamilton , Adam S. Kanter , David O. Okonkwo
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引用次数: 0

Abstract

Purpose

Adult spinal deformity (ASD) impacts patients’ quality-of-life. Minimally invasive surgery (MIS) can adequately treat carefully selected patients with ASD. Stand-alone lateral interbody fusion has been found effective in the treatment of low-grade degenerative spondylolisthesis, degenerative lumbar scoliosis as well as other degenerative spine conditions. However, the efficacy of anterolateral interbody fusion as an alternative approach to open spinal deformity correction has not been fully explored. Herein, the outcomes of patients who underwent standalone MIS anterolateral fusion were evaluated.

Methods

Patients with planned two-stage scoliosis correction from 2019 to 2021 were reviewed. Those whose preoperative symptoms improved after first-stage anterolateral MIS and did not undergo posterior fixation were identified. Spinopelvic parameters were measured with 36-inch-standing films. Oswestry disability index (ODI), visual analog scale (VAS) back and leg, and Scoliosis Research Society (SRS) average subdomain scores were collected.

Results

Eleven patients (3:8, male: female) were included. Mean age was 62.9 ± 8.0 years, BMI was 31.3 ± 4.3 kg/m2, and follow-up was 18.5 ± 12.6 months. Average preoperative spinopelvic parameters were: C7-sagittal vertical axis (C7-SVA) 51 mm, C7-sagittal-center vertical line (C7-SVL) 18.7 mm, pelvic incidence (PI) 47°, lumbar lordosis (LL) 36°, PI-LL mismatch 11°, pelvic tilt (PT) 23°, and coronal Cobb angle (CCA) 34°. Average spinopelvic parameters at first radiographic follow-up were: C7-SVA 29 mm (p = 0.002), C7-SVL 8 mm (p = 0.005), PI 47° (p = 0.455), LL 57° (p = 0.001), PI-LL mismatch −9.5° (p = 0.002), PT 18° (p = 0.004), and CCA 24° (p = 0.011). Besides lower LL, smaller PI-LL mismatch, and higher PT, there were no significant differences in radiographic parameters between first and last postoperative imaging. Significant improvements in ODI, VAS back and leg, and SRS average subdomain scores were identified (p < 0.05). No patients required hardware revision or second-stage fixation.

Conclusions

In select patients with adult spinal deformity, standalone anterolateral MIS fusion yielded enough radiographic correction and clinical improvement to defer or avoid the second stage of fusion. Longer-term follow-up and more studies are needed to establish its efficacy as a standard-of-care procedure.
成人脊柱畸形独立前外侧微创手术后症状和影像学结果的耐久性。
目的:成人脊柱畸形(ASD)影响患者的生活质量。微创手术(MIS)可以充分治疗精心挑选的ASD患者。独立侧位椎体间融合术在治疗低级别退行性腰椎滑脱、退行性腰椎侧凸以及其他退行性脊柱疾病中被发现是有效的。然而,前外侧椎体间融合术作为开放性脊柱畸形矫正的一种替代方法的疗效尚未得到充分的探讨。在此,我们评估了接受独立MIS前外侧融合的患者的预后。方法:对2019 - 2021年计划两期脊柱侧凸矫正的患者进行回顾性分析。那些在一期前外侧MIS后术前症状改善且未进行后路固定的患者被确定。用36英寸高的薄膜测量脊柱参数。采集Oswestry残疾指数(ODI)、背部和腿部视觉模拟量表(VAS)和脊柱侧凸研究学会(SRS)平均子域评分。结果:共纳入11例患者,男女比例为3:8。平均年龄62.9±8.0岁,BMI 31.3±4.3 kg/m2,随访18.5±12.6个月。术前平均脊柱参数为:c7 -矢状垂直轴(C7-SVA) 51 mm, c7 -矢状中心垂直线(C7-SVL) 18.7 mm,骨盆倾角(PI) 47°,腰椎前凸(LL) 36°,PI-LL不匹配11°,骨盆倾斜(PT) 23°,冠状Cobb角(CCA) 34°。首次x线随访时脊柱骨盆平均参数为:C7-SVA 29 mm (p = 0.002), C7-SVL 8 mm (p = 0.005), PI 47°(p = 0.455), LL 57°(p = 0.001), PI-LL失配-9.5°(p = 0.002), PT 18°(p = 0.004), CCA 24°(p = 0.011)。除了较低的LL、较小的PI-LL错配和较高的PT外,术后首次和最后一次影像学参数无显著差异。ODI、VAS背部和腿部以及SRS平均亚域评分均有显著改善(p)。结论:在选择的成人脊柱畸形患者中,独立的前外侧MIS融合获得了足够的影像学矫正和临床改善,可以推迟或避免第二阶段融合。需要长期随访和更多的研究来确定其作为标准治疗程序的有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Clinical Neuroscience
Journal of Clinical Neuroscience 医学-临床神经学
CiteScore
4.50
自引率
0.00%
发文量
402
审稿时长
40 days
期刊介绍: This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.
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