Minimal invasive posterior correction of Lenke 5C idiopathic scoliosis: comparative analysis of minimal invasive vs. open surgery

Abstract

Introduction Surgical management of adolescent idiopathic scoliosis in spite of usually favourable outcomes is still a major operation. Therefore, efforts are being undertaken to minimalize the procedure, reduce the surgical trauma and postoperative convalescence. The study was designed to compare posterior minimal invasive surgery using navigation based on intraoperative 3D imaging and standard open instrumented fusion in Lenke 5C idiopathic scoliosis treatment. Materials and methods From eight patients with Lenke 5C curves planned for posterior correction and instrumented fusion, four were treated with minimally invasive and four had open procedure. Operation length, estimated blood loss, number of fusion levels, days of opioid intake, length of hospital stay and radiation doses required were noted. Radiographic assessment of spinal curvatures was performed (magnitude, flexibility, sagittal alignment). The comparison of the data was done between open and minimally invasive treated patients. Results In minimally invasive surgery group, the operations were longer on average 285 min ± 47.5 than in the open surgery group, 242.5 min ± 44.5 ( p = 0.371) and resulted in slightly inferior coronal curve correction by 68.25% ± 6.2 vs. 78.25% ± 8.8, respectively ( p = 0.072). We observed a clear reduction of intraoperative blood loss in minimally invasive patients (mean 138.75 ± 50 vs. 450 ± 106 ml, p = 0.016), shorter hospital stay, average 3.75 vs. 7 days ( p = 0.043) and lower opioid requirements postoperatively − 2 vs. 3.25 days ( p = 0.015). Conclusions The minimally invasive approach to idiopathic scoliosis treatment is a very promising technique to limit the extent of surgery maintaining the same goals as in the open method. It allows for lower blood loss, less requirement for opioids and a shorter hospital stay.

Minimally Invasive Surgery versus Open Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis

“…This suggests that MIS is as good as the open surgery technique in attaining multilevel vertebral fusions. Urbanski et al [ 17 ] showed a significant difference in the number of days opioids were required, with a shorter period in the MIS group. Sarwahi et al [ 15 ] showed no difference between the two groups in opioid requirements, and our analysis favored the MIS group in this parameter.…”

“…Sarwahi et al [ 15 ] showed no difference between the two groups in opioid requirements, and our analysis favored the MIS group in this parameter. Gómez et al [ 16 ] and Sarwahi et al [ 15 ] showed a short duration of stay in the open surgery group, whereas Miyanji and Desai [ 14 ] and Urbanski et al [ 17 ] showed a shorter stay in the MIS group. Our analysis showed no difference between both groups in this parameter.…”

“…We were unable to access the full text of one article. Finally, six studies (one prospective and five retrospective comparative studies) met our inclusion criteria and were included for systematic review and meta-analysis [14][15][16][17][18][19] (Fig. 1).…”

Less correction with minimally invasive surgery for adolescent idiopathic scoliosis compared to open surgical correction

“…Navigation based on intraoperative 3D imaging can help to achieve more precise instrumented fusion. 8…”

“…As in our study, the operative blood loss was 218.3 ± 17.1 mL with a corrected angle of 76.1 ± 11.1 as compared to that published by other authors who had an operative blood loss of 138.75 ± 50.04 mL with corrected angle of 68.25% ± 6.1 %. 8 In reduction of the volume of bleeding, different additional methods can also play a role, including the use of hemostatic agent tranexamic acid or special techniques. 20 These modifications of surgical techniques applied to reduce tissue injuries and blood loss were offered, including endoscope-assisted spinal surgery.…”