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Long-term 2- to 5-Year Clinical and Functional Outcomes of Minimally Invasive Surgery for Adult Scoliosis

Anand, Neel MD, Mch Orth; Baron, Eli M. MD; Khandehroo, Babak MD; Kahwaty, Sheila PA-C

doi: 10.1097/BRS.0b013e31829cb67a

Study Design. A retrospective study.

Objective. We assess MIS technique's clinical and functional outcomes during a 2- to 5-year period.

Summary of Background Data. Traditional surgical approaches for adult scoliosis are associated with significant blood loss and morbidity, in a population that is often elderly with multiple medical comorbidities. Minimally invasive surgery (MIS) represents a newer method of achieving similar long-term outcomes but considerably lower morbidity and complication rates.

Methods. We reviewed 71 patients who underwent MIS correction of spinal deformity with fusion of 2 or more levels including: degenerative scoliosis (54), idiopathic scoliosis (11), and iatrogenic scoliosis (6). All underwent a combination of 3 MIS techniques: direct lateral interbody fusion (66), axial lumbar interbody fusion (34), and posterior instrumentation (67). Thirty-six patients were staged with direct lateral interbody fusion done first followed by the posterior instrumentation and fusion including axial lumbar interbody fusion done 3 days later.

Results. Mean age was 64 years (20–84 yr). Mean follow-up was 39 months (24–60 mo). Patients with 1-stage same-day surgery had a mean blood loss of 412 mL and a mean surgical time of 291 minutes. Patients with 2-stage surgery had a mean blood loss of 314 mL and surgical time of 183 minutes for direct lateral interbody fusion and 357 mL and 243 minutes, respectively for posterior instrumentation and axial lumbar interbody fusion. Mean hospital stay was 7.6 days (2–26 d). The mean preoperative Cobb angle was 24.7° (8.3°–65°), which corrected to 9.5° (0.6°–28.8°). Mean preoperative Coronal balance was 25.5 mm, which corrected to 11 mm. Mean preoperative sagittal balance was 31.7 mm and corrected to 10.7 mm. The mean preoperative lumbar apical vertebral translation was 24 mm and corrected to 12 mm. Fourteen patients had adverse events requiring intervention: 4 pseudarthrosis, 4 persistent stenosis, 1 osteomyelitis, 1 adjacent segment discitis, 1 late wound infection, 1 proximal junctional kyphosis, 1 screw prominence, 1 idiopathic cerebellar hemorrhage, and 2 wound dehiscence.

Conclusion. A combination of 3 novel MIS techniques allows comparable correction of adult spinal deformity, with low pseudarthrosis rates, significantly improved functional outcomes, and excellent clinical and radiological improvement, but considerably lowers morbidity and complication rates at early and long-term follow-up.

Minimally invasive deformity correction is a recently described surgical method for treating deformity. Few studies exist regarding long-term outcomes. Seventy-one patients underwent minimally invasive deformity correction and were followed for 2 to 5 years. Outcomes were similar to historical controls with reduced blood loss/hospital stays and maintenance of radiological correction. Neel Anand, Eli M. Baron, Babak Khandehroo, and Sheila Kahwaty

From the Cedars-Sinai Medical Center, Los Angeles, CA.

Address correspondence and reprint requests to Neel Anand, MD, Mch Orth, Cedars-Sinai Medical Center, 444 S. San Vicente Blvd., Ste 800, Los Angeles, CA 90048; E-mail:

Acknowledgment date: August 28, 2012. First revision date: March 20, 2013. Second revision date: May 2, 2013. Acceptance date: May 13, 2013.

DLIF, AxiaLIF, and RhBMP2 that are the subject of this manuscript are not FDA-approved for this indication and is commercially available in the United States.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, expert testimony, payment for lecture, royalties, stocks.

© 2013 by Lippincott Williams & Wilkins