Emerging Technologies in the Treatment of Adult Spinal Deformity

Patel, Akshar V.; White, Christopher A.; Schwartz, Jerome; Shah, Kush C.; Singh, Sirjanhar; Arvind, Varun; Kim, Jun; Cho, Samuel K.

doi:10.14245/ns.2142412.206

Cited by 14 publications

(12 citation statements)

References 80 publications

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“…One of the major issues after TES is the reconstruction of the spinal column. Solid bony fusion has been established as the most important factor to prevent mechanical failure when the 3 spinal columns are destabilized [ 15 - 17 ]. Even in the first report of TES by Dr. Tomita et al [ 1 ], a case of mechanical failure and a displaced pedicle screw were reported.…”

Section: Discussionmentioning

confidence: 99%

“…Instead, previous studies have suggested posterior revision surgery using multiple rods and an additional bone graft as an option [ 8 , 24 - 27 ]. A multiple-rod system has been suggested to be useful in deformity surgery, especially when 3 columns were resected to correct the deformity [ 15 - 17 , 28 - 32 ]. This suggestion is also applicable after TES [ 21 - 24 ].…”

Section: Discussionmentioning

confidence: 99%

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Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery

et al. 2022

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Objective: Total en bloc spondylectomy (TES) is a curative surgical method for spinal tumors. After resecting the 3 spinal columns, reconstruction is of paramount importance. We present cases of mechanical failure and suggest strategies for salvage surgery.Methods: The medical records of 19 patients who underwent TES (9 for primary tumors and 10 for metastatic tumors) were retrospectively reviewed. Previously reported surgical techniques were used, and the surgical extent was 1 level in 16 patients and 2 levels in 3 patients. A titanium-based mesh-type interbody spacer filled with autologous and cadaveric bone was used for anterior support, and a pedicle screw/rod system was used for posterior support. Radiotherapy was performed in 11 patients (pre-TES, 5; post-TES, 6). They were followed up for 59 ± 38 months (range, 11–133 months).Results: During follow-up, 8 of 9 primary tumor patients (89%) and 5 of 10 metastatic tumor patients (50%) survived (mean survival time, 124 ± 8 months vs. 51 ± 13 months; p = 0.11). Mechanical failure occurred in 3 patients (33%) with primary tumors and 2 patients (20%) with metastatic tumors (p = 0.63). The mechanical failure-free time was 94.4 ± 14 months (primary tumors, 95 ± 18 months; metastatic tumors, 68 ± 16 months; p = 0.90). Revision surgery was performed in 4 of 5 patients, and bilateral broken rods were replaced with dual cobalt-chromium alloy rods. Repeated rod fractures occurred in 1 of 4 patients 2 years later, and the third operation (with multiple cobalt-chromium alloy rods) was successful for over 6 years.Conclusion: Considering the difficulty of reoperation and patients’ suffering, preemptive use of a multiple-rod system may be advisable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery

et al. 2022

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“…ML uses computational algorithms from repeatedly trained data to develop mathematical models built using multiple variables and large quantities of data [81]. These complex algorithms can detect more subtle patterns in data than traditional statistical methods [87]. Kim et al [88] used ML to predict surgical complications in patients who underwent elective ASD surgery and found that it improved their risk prognostication system.…”

Section: Future Directionsmentioning

confidence: 99%

Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions

et al. 2022

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Owing to rapidly changing global demographics, adult spinal deformity (ASD) now accounts for a significant proportion of the Global Burden of Disease. Sagittal imbalance caused by age-related degenerative changes leads to back pain, neurological deficits, and deformity, which negatively affect the health-related quality of life (HRQoL) of patients. Along with the recognized regional, global, and sagittal spinopelvic parameters, poor paraspinal muscle quality has recently been acknowledged as a key determinant of the clinical outcomes of ASD. Although the Scoliosis Research Society-Schwab ASD classification system incorporates the radiological factors related to HRQoL, it cannot accurately predict the mechanical complications. With the rapid advances in surgical techniques, many surgical options for ASD have been developed, ranging from minimally invasive surgery to osteotomies. Therefore, structured patient-specific management is important in surgical decision-making, selecting the proper surgical technique, and to prevent serious complications in patients with ASD. Moreover, utilizing the latest technologies such as robotic-assisted surgery and machine learning, should help in minimizing the surgical risks and complications in the future.

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“…Recently, minimally invasive surgery (MIS) for spinal fusion is widely accepted as a safe and effective surgical method. [11][12][13] The intrinsic advantages of minimal tissue disruption have been related to decreased blood loss, shortened hospital stay, and improved postoperative surgical outcomes. These advantages may be particularly applicable to surgical patients with several medical comorbidities that are affected by lumbar deformities.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcome of minimal invasive oblique lateral interbody fusion with percutaneous pedicle screw fixation in the treatment of adult degenerative scoliosis

et al. 2022

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Oblique lateral interbody fusion is performed for lumbar spinal restoration and stabilization, without extensive paraspinal muscle damage or massive bleeding. This study aimed to confirm the radiological and clinical outcomes of minimally invasive oblique lateral interbody fusion (OLIF) with percutaneous pedicle screw fixation (PPSF) as treatment for adult degenerative lumbar scoliosis. Medical records of 40 patients with degenerative lumbar spinal deformities who underwent selective OLIF and PPSF at our hospital between April 2018 and February 2021 were retrospectively reviewed. The study population comprised 7 male and 33 female patients aged 55–79 years. Standing radiography was performed, and the coronal cobb angle, distance between the C7 plumb line and central sacral vertical line, sagittal vertical axis, pelvic tilt, lumbar lordosis (LL), pelvic incidence (PI), and difference between PI and LL (PI-LL) were measured. Coronal scoliosis was defined as a lumbar coronal plane curve of > 15°. All patients achieved statistically significant improvements in coronal and sagittal alignment. The coronal cobb angle was corrected from 18.82° to 11.52°, and the central sacral vertical line was reduced from 18.30 mm to 15.47 mm. The sagittal vertical axis was significantly reduced from 45.95 mm to 32.72 mm. In contrast, the pelvic tilt and LL were minimally changed. For subgroup analyses, patients were divided into the convex and concave groups according to the direction of coronal curve correction. Vertebral body rotation was superior in the convex group than in the concave group. Furthermore, we checked for asymmetric facet degeneration at the upper instrumented vertebra (UIV) level at 1 year postoperatively. Of the 22 patients who underwent more than 3 level fusion surgery, 8 patients were confirmed the postoperative asymmetric facet degeneration in above UIV. Minor complications occurred in 16 patients, who recovered without any problems. Revision surgery was not performed in all cases. Minimally invasive OLIF with PPSF has a lower risk of complications and favorable surgical outcomes in patients with adult degenerative lumbar scoliosis. Access from the convex side is advantageous for the correction of the rotated vertebra. Extending the UIV level to the neutral vertebra can reduce the occurrence of postoperative asymmetric facet degeneration.

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Emerging Technologies in the Treatment of Adult Spinal Deformity

Cited by 14 publications

References 80 publications

Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery

Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery

Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions

Surgical outcome of minimal invasive oblique lateral interbody fusion with percutaneous pedicle screw fixation in the treatment of adult degenerative scoliosis

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