title: Reoperation rates in minimally invasive, hybrid and open surgical treatment for adult spinal deformity with minimum 2-year follow-up.
abstract: Minimally invasive surgical (MIS) techniques are gaining popularity in the treatment of adult spinal deformity (ASD). The premise is that MIS techniques will lead to equivalent outcomes and a reduction in perioperative complications when compared with open techniques. Potential issues with MIS techniques are a limited capacity to correct lumbar lordosis, unknown long-term efficacy, and the potential need for revision surgery. This study compares reoperation rates and reasons for reoperation following MIS, hybrid, and open surgery for ASD through multicenter database analysis.
  
  
  
  We retrospectively analyzed a prospective multicenter ASD database comparing open and MIS correction techniques. Inclusion criteria were: age > 18 years with minimum 20° coronal lumbar Cobb angle, a minimum of three levels fused, and minimum 2-year follow-up. Patients were propensity matched for preoperative sagittal vertebral axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), and number of levels fused. We included 189 patients from three propensity-matched subgroups of 63 patients each: (1) MIS: lateral or transforaminal lumbar interbody fusion (LIF) and percutaneous pedicle instrumentation, (2) Hybrid: MIS LIF with open posterior segmental fixation (PSF), and (3) OPEN: open posterior fixation ± osteotomies.
  
  
  
  With propensity matching, there were significant differences between groups in pre-op SVA or PI-LL (p > 0.05). The MIS group had significantly fewer levels fused (5.4) (0-14) than the OPEN group (7.4) (p = 0.002) (0-17). The rate of revision surgery was significantly different between the groups with a higher rate of revision (27 %) amongst the HYB group versus MIS = 11.1 %, and OPEN = 12.0 %. The most common reason for reoperation in the OPEN and HYB groups was a postoperative neurological deficit (7.9 and 11.1 %), respectively. The most common reason for reoperation in the MIS group was pseudoarthrosis (7.9 %).
  
  
  
  Reoperation rates were not statistically different among the MIS, and OPEN surgical groups, but differed significantly on multivariate analysis with HYB group. The incidence of reoperations was twice as high in the Hybrid group compared to OPEN and MIS.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA, 15213, USA. dkojoh@gmail.com.
authors.forename: D Kojo
authors.initials: DK
authors.lastname: Hamilton
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA, 15213, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kanter
authors.affiliation: Geisinger Neurosurgery, Geisinger Medical Center, Danville, PA, USA.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Bolinger
authors.affiliation: San Diego Center for Spinal Disorders, La Jolla, CA, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Mundis
authors.affiliation: San Diego Center for Spinal Disorders, La Jolla, CA, USA.
authors.forename: Stacie
authors.initials: S
authors.lastname: Nguyen
authors.affiliation: Department of Neurosurgery, University of California San Francisco Medical Center, San Francisco, CA, USA.
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.affiliation: Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Neel
authors.initials: N
authors.lastname: Anand
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Fessler
authors.affiliation: Department of Orthopedic Surgery, NYU Hospital for Joint Disease, New York, NY, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: La Marca
authors.affiliation: Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA.
authors.forename: Juan S
authors.initials: JS
authors.lastname: Uribe
authors.affiliation: Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Wang
authors.affiliation: San Diego Center for Spinal Disorders, La Jolla, CA, USA.
authors.forename: Behrooz A
authors.initials: BA
authors.lastname: Akbarnia
authors.affiliation: Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA, 15213, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Okonkwo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data*; D013121:Spinal Curvatures / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Adult spinal deformity; Hybrid; Minimally invasive; Revision