Minimally invasive surgery in adult degenerative scoliosis: a systematic review and meta-analysis of decompression, anterior/lateral and posterior lumbar approaches.
BACKGROUND
Minimally invasive approaches for the treatment of adult degenerative scoliosis have been increasingly implemented. However, little data exists regarding the safety and complication profiles of minimally invasive lumbar interbody fusion (LIF) for adult degenerative scoliosis. This study aimed to greater understand different minimally invasive surgical approaches for adult degenerative scoliosis with respect to clinical outcomes, changes in radiographic measurements, and complication profiles via meta-analytical techniques.


METHODS
A systematic search of six databases from inception to September 2015 was performed by two independent reviewers. Relevant studies were those that described the safety and/or effectiveness of minimally invasive anterior or lateral LIF (LLIF), transforaminal LIF (TLIF), and decompression only. Meta-analytical techniques and meta-regression were used to pool overall rates, and compare the different techniques. There was no financial funding or conflict of interest.


RESULTS
A total of 29 studies (1,228 patients) were included in this meta-analysis. Total pooled fusion rate was 95.9% (95% CI: 92.7-98.2%) for the anterior/lateral approach. The pooled construct or hardware-related complications was 4.3%, and was similar among anterior/lateral (4.4%) and posterior (5.2%) techniques. The total pooled pseudoarthrosis rate was 4.3% for the lateral approach. The overall pooled rate of motor deficit was 2.7% (95% CI: 1.7-4.0%). Subgroup meta-regression demonstrated that the anterior/lateral approach had the highest rate of motor deficits (3.6% LLIF vs. 0.7% TLIF vs. 0.5% decompression, P=0.004). The overall pooled rate of sensory deficit was 2.4%, highest for the anterior/lateral technique (3.3%) compared to TLIF (0.7%) and decompression (0.5%). The infection rate, dural tears/CSF leak, cardiac and pulmonary events were similar among the techniques, with a pooled value of 2.6%, 3.9%, 1.7%, and 1.4%, respectively. Similarly satisfactory radiological outcomes were obtained amongst the different approaches.


CONCLUSIONS
Minimally invasive spine technologies may be used for the surgical treatment of lumbar degenerative scoliosis with acceptable complication rates, functional and radiological outcome. Future studies, specifically multi-centered longitudinal, examining the adequacy of minimally invasive spine surgery is warranted to compare long-term outcomes with the traditional procedure.
NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of Sydney, Sydney, Australia;
Kevin
K
Phan
Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia ;
Ya Ruth
YR
Huo
NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia;
Jarred A
JA
Hogan
Faculty of Medicine, University of Sydney, Sydney, Australia ;
Joshua
J
Xu
NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia ;
Alexander
A
Dunn
Leni & Peter W May Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, USA ;
Samuel K
SK
Cho
NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia;
Ralph J
RJ
Mobbs
Department of Orthopaedic Surgery, Royal Berkshire Hospital, Reading, UK ;
Patrick
P
McKenna
Department of Orthopaedic Surgery, Royal Berkshire Hospital, Reading, UK ;
Trichy
T
Rajagopal
Department of Orthopaedic Surgery, Royal North Shore Hospital, Sydney, Australia.
Farhaan
F
Altaf
Minimally invasive; adult; degenerative spine; lumbar spine fusion; meta-analysis; review; scoliosis
Neurosurgery. 2002 Nov;51(5 Suppl):S155-8
12234443
J Spinal Disord Tech. 2005 Feb;18 Suppl:S1-6
15699793
Spine (Phila Pa 1976). 1992 May;17(5):518-27
1621151
J Neurosurg Spine. 2005 Sep;3(3):218-23
16235705
Eur Spine J. 2005 Dec;14(10):925-48
16328223
J Neurosurg Spine. 2005 Aug;3(2):98-105
16370298
Neurosurg Focus. 2006 Mar 15;20(3):E10
16599416
Spine J. 2006 Jul-Aug;6(4):435-43
16825052
Spine (Phila Pa 1976). 2006 Sep 15;31(20):E748-53
16985443
Spine (Phila Pa 1976). 2007 Mar 1;32(5):537-43
17334287
Spine (Phila Pa 1976). 2007 Nov 15;32(24):2764-70
18007258
Spine (Phila Pa 1976). 2008 Sep 15;33(20):2243-7
18794768
Neurosurgery. 2008 Sep;63(3 Suppl):191-6
18812924
J Spinal Disord Tech. 2008 Oct;21(7):459-67
18836355
Neurosurgery. 2009 Jul;65(1):86-93; discussion 93-4
19574829
Spine (Phila Pa 1976). 2009 Jul 15;34(16):1693-8
19770610
Neurosurg Focus. 2010 Mar;28(3):E7
20192667
Neurosurg Focus. 2010 Mar;28(3):E8
20192668
Neurosurg Focus. 2010 Mar;28(3):E9
20192721
Spine (Phila Pa 1976). 2010 Sep 1;35(19):E981-7
20386501
J Bone Joint Surg Am. 1991 Jul;73(6):802-8
2071615
Spine (Phila Pa 1976). 2010 Sep 15;35(20):1872-5
20802398
J Neurosurg Spine. 2010 Dec;13(6):758-65
21121755
J Spinal Disord Tech. 2011 Aug;24(6):368-75
21150667
Spine (Phila Pa 1976). 2010 Dec 15;35(26 Suppl):S322-30
21160396
Spine (Phila Pa 1976). 2011 May 20;36(12):958-64
21192289
Spine (Phila Pa 1976). 2011 Apr 20;36(9):E593-7
21325989
J Neurosurg Spine. 2011 Jul;15(1):92-6
21476802
Orthop Surg. 2009 Aug;1(3):176-83
22009839
ScientificWorldJournal. 2012;2012:516706
22919332
ScientificWorldJournal. 2012;2012:680643
23049476
J Neurosurg Spine. 2013 Jan;18(1):4-12
23101944
ScientificWorldJournal. 2012;2012:789698
23304089
J Clin Neurosci. 2013 Apr;20(4):576-81
23375396
Spine (Phila Pa 1976). 2013 Aug 15;38(18):1566-75
23715025
Spine (Phila Pa 1976). 2013 Oct 1;38(21):1853-61
23873244
HSS J. 2012 Jul;8(2):122-7
23874250
Neurosurg Focus. 2013 Aug;35(2):E4
23905955
J Clin Neurosci. 2013 Nov;20(11):1558-63
23906522
Clin Orthop Relat Res. 2014 Jun;472(6):1776-83
23996097
Eur Spine J. 2014 Jun;23(6):1215-23
24619605
J Neurosurg Spine. 2014 May;20(5):515-22
24628129
Ochsner J. 2014 Spring;14(1):23-31
24688329
Clin Spine Surg. 2016 Oct;29(8):323-30
25140537
J Clin Neurosci. 2015 Apr;22(4):740-6
25684343
Int J Spine Surg. 2014 Dec 01;8:null
25694921
Eur J Orthop Surg Traumatol. 2015 Jul;25 Suppl 1:S29-33
25971442
J Clin Neurosci. 2015 Nov;22(11):1714-21
26190218
J Neurosurg Spine. 2015 Dec;23(6):739-46
26315959
Spine (Phila Pa 1976). 2016 Apr;41 Suppl 8:S66-73
26839994
J Spine Surg. 2015 Dec;1(1):2-18
27683674
J Spine Surg. 2015 Dec;1(1):19-27
27683675
J Bone Joint Surg Am. 1981 Feb;63(2):268-87
6450768
Spine (Phila Pa 1976). 1993 Nov;18(15):2227-30
8278837
Surg Laparosc Endosc. 1996 Dec;6(6):459-68
8948039