Title : Minimally invasive approach to adult spine deformity using minimally invasive stabilization (MISt) technique
Abstract:
Minimally invasive spine surgery (MIS) was not applicable to the adult patients with spinal deformity having a worsened global balance on the sagittal plane. Recently, XLIF has enabled a frontal approach to dissociate intervertebral disc and minimally invasive insertion of cage with a frontal angle of 10 degrees in all cases except for L5/S. In this study, we present our minimally invasive approaches for the treatment of spinal deformity in adult patients admitted to our hospital.
Subjects and methods: Fifty-eight patients (26 men and 32 women, average age 72.6 years) with spine deformity due to kyphosis or scoliosis who underwent MIS using XLIF were studied.
Results: Total blood loss was the least (662 g). The average bed rest period was 3.2 days. X-ray evaluations before and after operation revealed that 1) SVA was improved from 12.3° to 6.4° 2) LL was improved from 12.5° to 43.8°. 3) PT was improved from 39.7° to 24.5°. 4) PI-LL became 10.1°.
Discussion: Minimally invasive approach is very important in corrective spinal fusion surgery for the treatment of spine deformity because most patients are old. Clinical outcomes, however, are not satisfactory even though minimal invasiveness is achieved using PPS if adequate correction cannot be obtained. We divided the patients in 3 groups and applied PPS in different ways to achieve similar clinical outcomes to open surgery. We could attain satisfactory correction in every group.
Conclusion: Satisfactory correction and minimal invasiveness in spinal fusion surgery for the treatment of adult spine deformity is possible using XLIF and PPS if we apply this method to appropriate patients.
