title: Combined "hybrid" open and minimally invasive surgical correction of adult thoracolumbar scoliosis:  a retrospective cohort study.
abstract: BACKGROUND
  Surgery for scoliosis requires extensive exposure, resulting in significant tissue injury and longer recovery times. To minimize morbidity in scoliosis surgery, several studies have shown successful application of a combination of minimally invasive techniques; however, the extent of scoliosis treated has been modest.
  
  
  OBJECTIVE
  To achieve some of the benefits of minimally invasive surgery and yet treat curves of greater degree, we have used a combined approach, incorporating both open and minimally invasive techniques.
  
  
  METHODS
  We analyzed a prospectively acquired database in addition to reviewing electronic records of patients undergoing hybrid surgery for thoracolumbar scoliosis. Nine patients were identified. The minimally invasive portion involved the lumbar region in all cases. Pain was assessed by the visual analog scale and disability was measured by the Oswestry Disability Index.
  
  
  RESULTS
  Mean preoperative scoliosis was 47.8 degrees, which was corrected to a mean 15.2 degrees. An average of 7.8 spinal levels was treated. Estimated blood loss averaged 1094.4 mL, and length of hospital stay averaged 7.2 days. Acute complications occurred in 2 patients. Longer term complications occurred in 2 patients, consisting of adjacent segment disease. The mean improvement in the visual analog scale score was 3.7 and the mean improvement on the Oswestry Disability Index was 30.5. Average follow-up was 29.2 months.
  
  
  CONCLUSIONS
  The hybrid approach for the treatment of scoliosis results in acceptable radiographic and clinical outcomes. Complications did not appear increased compared with those expected with scoliosis surgery. Although decreased adjacent tissue injury was achieved with the minimally invasive component of the procedure, a larger comparative study is required to determine magnitude of this benefit.
authors.affiliation: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Room 3552, Taubman Center, Ann Arbor, MI 48109-5338, USA. ppark@umich.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Park
authors.forename: Frank
authors.initials: F
authors.lastname: La Marca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D010147:Pain Measurement; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013904:Thoracic Vertebrae / Q000601:surgery; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult