Comparison of radiographic results after minimally invasive, hybrid, and open surgery for adult spinal deformity: A multicenter study of 184 patients

Raqeeb M. Haque, Gregory M. Mundis, Yousef Ahmed, Tarek Y. El Ahm adieh, Michael Y. Wang, Praveen V. Mummaneni, Juan S. Uribe, David O. Okonkwo, Robert K. Eastlack, Neel Anand, Adam S. Kanter, Frank La Marca, Behrooz A. Akbarnia, Paul Park, Virg inie Lafage, Jamie S. Terran, Christopher I. Shaffrey, Eric Klineberg, Vedat Deviren, Richard G. Fessler

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Object: Various surgical approaches, including open, minimally invasive, and hybrid techniques, have gained momentum in the management of adult spinal deformity. However, few data exist on the radiographic outcomes of different surgical techniques. The objective of this study was to compare the radiographic and clinical outcomes of the surgical techniques used in the treatment of adult spinal deformity. Methods: The authors conducted a retrospective review of two adult spinal deformity patient databases, a prospective open surgery database and a retrospective minimally invasive surgery (MIS) and hybrid surgery database. The time frame of enrollment in this study was from 2007 to 201 Spinal deformity patients were stratified into 3 surgery groups: MIS, hybrid surgery, and open surgery. The following pre- and postoperative radiographic parameters were assessed: lumbar major Cobb angle, lumbar lordosis, pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis, and pelvic tilt. Scores on the Oswestry Disability Index (ODI) and a visual analog scale (VAS) for both back and leg pain were also obtained from each patient. Results: Of the 234 patients with adult spinal deformity, 184 patients had pre- and postoperative radiographs and were thus included in the study (MIS, n = 42; hybrid, n = 33; open, n = 109). Patients were a mean of 61.7 years old and had a mean body mass index of 26.9 kg/m Regarding radiographic outcomes, the MIS group maintained a significantly smaller mean lumbar Cobb angle (13.1°) after surgery compared with the open group (20.4°, p = 0.002), while the hybrid group had a significantly larger lumbar curve correction (26.6°) compared with the MIS group (18.8°, p = 0.045). The mean change in the PI-LL was larger for the hybrid group (20.6°) compared with the open (10.2°, p = 0.023) and MIS groups (5.5°, p = 0.003). The mean sagittal vertical axis correction was greater for the open group (25 mm) compared with the MIS group (≤ 1 mm, p = 0.008). Patients in the open group had a significantly larger postoperative thoracic kyphosis (41.45°) compared with the MIS patients (33.5°, p = 0.005). There were no significant differences between groups in terms of pre- and postoperative mean ODI and VAS scores at the 1-year follow-up. However, patients in the MIS group had much lower estimated blood loss and transfusion rates compared with patients in the hybrid or open groups (p < 0.001). Operating room time was significantly longer with the hybrid group compared with the MIS and open groups (p < 0.001). Major complications occurred in 14% of patients in the MIS group, 14% in the hybrid group, and 45% in the open group (p = 0.032). Conclusions: This study provides valuable baseline characteristics of radiographic parameters among 3 different surgical techniques used in the treatment of adult spinal deformity. Each technique has advantages, but much like any surgical technique, the positive and negative elements must be considered when tailoring a treatment to a patient. Minimally invasive surgical techniques can result in clinical outcomes at 1 year comparable to those obtained from hybrid and open surgical techniques.

Original languageEnglish
Article numberE13
JournalNeurosurgical Focus
Volume36
Issue number5
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Minimally Invasive Surgical Procedures
Multicenter Studies
Lordosis
Databases
Visual Analog Scale
Kyphosis
Incidence
Operating Rooms
Back Pain
Blood Transfusion
Leg
Body Mass Index
Thorax
Therapeutics

Keywords

  • Adult spinal deformity
  • Clinical outcome
  • Hybrid technique
  • Minimally invasive surgery
  • Open surgery
  • Radiographic outcome

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Comparison of radiographic results after minimally invasive, hybrid, and open surgery for adult spinal deformity : A multicenter study of 184 patients. / Haque, Raqeeb M.; Mundis, Gregory M.; Ahmed, Yousef; El Ahm adieh, Tarek Y.; Wang, Michael Y.; Mummaneni, Praveen V.; Uribe, Juan S.; Okonkwo, David O.; Eastlack, Robert K.; Anand, Neel; Kanter, Adam S.; La Marca, Frank; Akbarnia, Behrooz A.; Park, Paul; Lafage, Virg inie; Terran, Jamie S.; Shaffrey, Christopher I.; Klineberg, Eric; Deviren, Vedat; Fessler, Richard G.

In: Neurosurgical Focus, Vol. 36, No. 5, E13, 01.01.2014.

Research output: Contribution to journalArticle

Haque, RM, Mundis, GM, Ahmed, Y, El Ahm adieh, TY, Wang, MY, Mummaneni, PV, Uribe, JS, Okonkwo, DO, Eastlack, RK, Anand, N, Kanter, AS, La Marca, F, Akbarnia, BA, Park, P, Lafage, VI, Terran, JS, Shaffrey, CI, Klineberg, E, Deviren, V & Fessler, RG 2014, 'Comparison of radiographic results after minimally invasive, hybrid, and open surgery for adult spinal deformity: A multicenter study of 184 patients', Neurosurgical Focus, vol. 36, no. 5, E13. https://doi.org/10.3171/2014.3.FOCUS1424
Haque, Raqeeb M. ; Mundis, Gregory M. ; Ahmed, Yousef ; El Ahm adieh, Tarek Y. ; Wang, Michael Y. ; Mummaneni, Praveen V. ; Uribe, Juan S. ; Okonkwo, David O. ; Eastlack, Robert K. ; Anand, Neel ; Kanter, Adam S. ; La Marca, Frank ; Akbarnia, Behrooz A. ; Park, Paul ; Lafage, Virg inie ; Terran, Jamie S. ; Shaffrey, Christopher I. ; Klineberg, Eric ; Deviren, Vedat ; Fessler, Richard G. / Comparison of radiographic results after minimally invasive, hybrid, and open surgery for adult spinal deformity : A multicenter study of 184 patients. In: Neurosurgical Focus. 2014 ; Vol. 36, No. 5.
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abstract = "Object: Various surgical approaches, including open, minimally invasive, and hybrid techniques, have gained momentum in the management of adult spinal deformity. However, few data exist on the radiographic outcomes of different surgical techniques. The objective of this study was to compare the radiographic and clinical outcomes of the surgical techniques used in the treatment of adult spinal deformity. Methods: The authors conducted a retrospective review of two adult spinal deformity patient databases, a prospective open surgery database and a retrospective minimally invasive surgery (MIS) and hybrid surgery database. The time frame of enrollment in this study was from 2007 to 201 Spinal deformity patients were stratified into 3 surgery groups: MIS, hybrid surgery, and open surgery. The following pre- and postoperative radiographic parameters were assessed: lumbar major Cobb angle, lumbar lordosis, pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis, and pelvic tilt. Scores on the Oswestry Disability Index (ODI) and a visual analog scale (VAS) for both back and leg pain were also obtained from each patient. Results: Of the 234 patients with adult spinal deformity, 184 patients had pre- and postoperative radiographs and were thus included in the study (MIS, n = 42; hybrid, n = 33; open, n = 109). Patients were a mean of 61.7 years old and had a mean body mass index of 26.9 kg/m Regarding radiographic outcomes, the MIS group maintained a significantly smaller mean lumbar Cobb angle (13.1°) after surgery compared with the open group (20.4°, p = 0.002), while the hybrid group had a significantly larger lumbar curve correction (26.6°) compared with the MIS group (18.8°, p = 0.045). The mean change in the PI-LL was larger for the hybrid group (20.6°) compared with the open (10.2°, p = 0.023) and MIS groups (5.5°, p = 0.003). The mean sagittal vertical axis correction was greater for the open group (25 mm) compared with the MIS group (≤ 1 mm, p = 0.008). Patients in the open group had a significantly larger postoperative thoracic kyphosis (41.45°) compared with the MIS patients (33.5°, p = 0.005). There were no significant differences between groups in terms of pre- and postoperative mean ODI and VAS scores at the 1-year follow-up. However, patients in the MIS group had much lower estimated blood loss and transfusion rates compared with patients in the hybrid or open groups (p < 0.001). Operating room time was significantly longer with the hybrid group compared with the MIS and open groups (p < 0.001). Major complications occurred in 14{\%} of patients in the MIS group, 14{\%} in the hybrid group, and 45{\%} in the open group (p = 0.032). Conclusions: This study provides valuable baseline characteristics of radiographic parameters among 3 different surgical techniques used in the treatment of adult spinal deformity. Each technique has advantages, but much like any surgical technique, the positive and negative elements must be considered when tailoring a treatment to a patient. Minimally invasive surgical techniques can result in clinical outcomes at 1 year comparable to those obtained from hybrid and open surgical techniques.",
keywords = "Adult spinal deformity, Clinical outcome, Hybrid technique, Minimally invasive surgery, Open surgery, Radiographic outcome",
author = "Haque, {Raqeeb M.} and Mundis, {Gregory M.} and Yousef Ahmed and {El Ahm adieh}, {Tarek Y.} and Wang, {Michael Y.} and Mummaneni, {Praveen V.} and Uribe, {Juan S.} and Okonkwo, {David O.} and Eastlack, {Robert K.} and Neel Anand and Kanter, {Adam S.} and {La Marca}, Frank and Akbarnia, {Behrooz A.} and Paul Park and Lafage, {Virg inie} and Terran, {Jamie S.} and Shaffrey, {Christopher I.} and Eric Klineberg and Vedat Deviren and Fessler, {Richard G.}",
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TY - JOUR

T1 - Comparison of radiographic results after minimally invasive, hybrid, and open surgery for adult spinal deformity

T2 - A multicenter study of 184 patients

AU - Haque, Raqeeb M.

AU - Mundis, Gregory M.

AU - Ahmed, Yousef

AU - El Ahm adieh, Tarek Y.

AU - Wang, Michael Y.

AU - Mummaneni, Praveen V.

AU - Uribe, Juan S.

AU - Okonkwo, David O.

AU - Eastlack, Robert K.

AU - Anand, Neel

AU - Kanter, Adam S.

AU - La Marca, Frank

AU - Akbarnia, Behrooz A.

AU - Park, Paul

AU - Lafage, Virg inie

AU - Terran, Jamie S.

AU - Shaffrey, Christopher I.

AU - Klineberg, Eric

AU - Deviren, Vedat

AU - Fessler, Richard G.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Object: Various surgical approaches, including open, minimally invasive, and hybrid techniques, have gained momentum in the management of adult spinal deformity. However, few data exist on the radiographic outcomes of different surgical techniques. The objective of this study was to compare the radiographic and clinical outcomes of the surgical techniques used in the treatment of adult spinal deformity. Methods: The authors conducted a retrospective review of two adult spinal deformity patient databases, a prospective open surgery database and a retrospective minimally invasive surgery (MIS) and hybrid surgery database. The time frame of enrollment in this study was from 2007 to 201 Spinal deformity patients were stratified into 3 surgery groups: MIS, hybrid surgery, and open surgery. The following pre- and postoperative radiographic parameters were assessed: lumbar major Cobb angle, lumbar lordosis, pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis, and pelvic tilt. Scores on the Oswestry Disability Index (ODI) and a visual analog scale (VAS) for both back and leg pain were also obtained from each patient. Results: Of the 234 patients with adult spinal deformity, 184 patients had pre- and postoperative radiographs and were thus included in the study (MIS, n = 42; hybrid, n = 33; open, n = 109). Patients were a mean of 61.7 years old and had a mean body mass index of 26.9 kg/m Regarding radiographic outcomes, the MIS group maintained a significantly smaller mean lumbar Cobb angle (13.1°) after surgery compared with the open group (20.4°, p = 0.002), while the hybrid group had a significantly larger lumbar curve correction (26.6°) compared with the MIS group (18.8°, p = 0.045). The mean change in the PI-LL was larger for the hybrid group (20.6°) compared with the open (10.2°, p = 0.023) and MIS groups (5.5°, p = 0.003). The mean sagittal vertical axis correction was greater for the open group (25 mm) compared with the MIS group (≤ 1 mm, p = 0.008). Patients in the open group had a significantly larger postoperative thoracic kyphosis (41.45°) compared with the MIS patients (33.5°, p = 0.005). There were no significant differences between groups in terms of pre- and postoperative mean ODI and VAS scores at the 1-year follow-up. However, patients in the MIS group had much lower estimated blood loss and transfusion rates compared with patients in the hybrid or open groups (p < 0.001). Operating room time was significantly longer with the hybrid group compared with the MIS and open groups (p < 0.001). Major complications occurred in 14% of patients in the MIS group, 14% in the hybrid group, and 45% in the open group (p = 0.032). Conclusions: This study provides valuable baseline characteristics of radiographic parameters among 3 different surgical techniques used in the treatment of adult spinal deformity. Each technique has advantages, but much like any surgical technique, the positive and negative elements must be considered when tailoring a treatment to a patient. Minimally invasive surgical techniques can result in clinical outcomes at 1 year comparable to those obtained from hybrid and open surgical techniques.

AB - Object: Various surgical approaches, including open, minimally invasive, and hybrid techniques, have gained momentum in the management of adult spinal deformity. However, few data exist on the radiographic outcomes of different surgical techniques. The objective of this study was to compare the radiographic and clinical outcomes of the surgical techniques used in the treatment of adult spinal deformity. Methods: The authors conducted a retrospective review of two adult spinal deformity patient databases, a prospective open surgery database and a retrospective minimally invasive surgery (MIS) and hybrid surgery database. The time frame of enrollment in this study was from 2007 to 201 Spinal deformity patients were stratified into 3 surgery groups: MIS, hybrid surgery, and open surgery. The following pre- and postoperative radiographic parameters were assessed: lumbar major Cobb angle, lumbar lordosis, pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis, and pelvic tilt. Scores on the Oswestry Disability Index (ODI) and a visual analog scale (VAS) for both back and leg pain were also obtained from each patient. Results: Of the 234 patients with adult spinal deformity, 184 patients had pre- and postoperative radiographs and were thus included in the study (MIS, n = 42; hybrid, n = 33; open, n = 109). Patients were a mean of 61.7 years old and had a mean body mass index of 26.9 kg/m Regarding radiographic outcomes, the MIS group maintained a significantly smaller mean lumbar Cobb angle (13.1°) after surgery compared with the open group (20.4°, p = 0.002), while the hybrid group had a significantly larger lumbar curve correction (26.6°) compared with the MIS group (18.8°, p = 0.045). The mean change in the PI-LL was larger for the hybrid group (20.6°) compared with the open (10.2°, p = 0.023) and MIS groups (5.5°, p = 0.003). The mean sagittal vertical axis correction was greater for the open group (25 mm) compared with the MIS group (≤ 1 mm, p = 0.008). Patients in the open group had a significantly larger postoperative thoracic kyphosis (41.45°) compared with the MIS patients (33.5°, p = 0.005). There were no significant differences between groups in terms of pre- and postoperative mean ODI and VAS scores at the 1-year follow-up. However, patients in the MIS group had much lower estimated blood loss and transfusion rates compared with patients in the hybrid or open groups (p < 0.001). Operating room time was significantly longer with the hybrid group compared with the MIS and open groups (p < 0.001). Major complications occurred in 14% of patients in the MIS group, 14% in the hybrid group, and 45% in the open group (p = 0.032). Conclusions: This study provides valuable baseline characteristics of radiographic parameters among 3 different surgical techniques used in the treatment of adult spinal deformity. Each technique has advantages, but much like any surgical technique, the positive and negative elements must be considered when tailoring a treatment to a patient. Minimally invasive surgical techniques can result in clinical outcomes at 1 year comparable to those obtained from hybrid and open surgical techniques.

KW - Adult spinal deformity

KW - Clinical outcome

KW - Hybrid technique

KW - Minimally invasive surgery

KW - Open surgery

KW - Radiographic outcome

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