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A Review of Minimally Invasive Procedures for the Treatment of Adult Spinal Deformity

Kanter, Adam S. MD; Tempel, Zachary J. MD; Ozpinar, Alp MD; Okonkwo, David O. MD, PhD

doi: 10.1097/BRS.0000000000001481
Literature Review

Study Design. Literature review.

Objective. To review the literature evaluating the role of minimally invasive (MIS) techniques in the operative treatment of adult spinal deformity (ASD).

Summary of Background Data. MIS techniques have become important tools in the armamentarium of spinal deformity surgeons as a means of achieving coronal and sagittal plane correction, while minimizing the complications of open deformity surgery. The literature suggests that MIS techniques are associated with certain limitations, and to date, determining which patients are candidates for MIS deformity correction is largely based on surgeon experience.

Methods. A systematic literature review was performed using the PubMed-National Library of Medicine/National Institute of Health databases. All studies describing the use of MIS techniques in ASD surgery were included for review.

Results. A total of 39 articles were included in the review. All studies were specifically designed to demonstrate radiographic and clinical outcomes of MIS techniques. Thirty articles were specific to MIS techniques as they relate to ASD surgery, whereas six articles were designed to describe details of various MIS techniques, and three articles were related to general principles of corrective surgery for ASD.

Conclusion. The literature has demonstrated that MIS techniques are effective in achieving radiographic correction after surgery for ASD, while reducing complications compared with traditional open surgery. However, MIS techniques have limitations and may not be as effective as open surgery for severe and/or fixed sagittal and coronal plane deformity. Therefore, selecting patients for stand-alone MIS versus circumferential (cMIS) versus hybrid MIS (hybMIS) is critically important. The MIS spinal deformity surgery algorithm was designed to address this topic. Further studies are required to better elucidate the role and limitations of MIS techniques in patient undergoing corrective surgery for ASD.

Level of Evidence: N/A

Department of Neurological Surgery, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Address correspondence and reprint requests to Adam S. Kanter, MD, Department of Neurological Surgery, 200 Lothrop Street Suite B400, Pittsburgh, PA 15213; E-mail:

Received 27 October, 2015

Revised 25 January, 2016

Accepted 26 January, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants, travel/accommodations/meeting expenses.

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