Neurosurg Focus
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Comparative Study
Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis.
The goal of this study was to assess the operative outcomes of adult patients with scoliosis who were treated surgically with minimally invasive correction and fusion. ⋯ Minimally invasive surgical correction of adult scoliosis results in mid- to long-term outcomes similar to traditional surgical approaches. Whereas operating times are comparable to those achieved with open approaches, blood loss and morbidity appear to be significantly lower in patients undergoing minimally invasive deformity correction. This approach may be particularly useful in the elderly.
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The authors recently used a combined approach of minimally invasive transpsoas extreme lateral interbody fusion (XLIF) and open posterior segmental pedicle screw instrumentation with transforaminal lumbar interbody fusion (TLIF) for the correction of coronal deformity. The complications and radiographic outcomes were compared with a posterior-only approach for scoliosis correction. ⋯ Radiographic outcomes such as the Cobb angle and AVT were significantly improved in patients who underwent a combined transpsoas and posterior approach. Lumbar lordosis was maintained in all patients undergoing the combined approach. The combination of XLIF and TLIF/posterior segmental instrumentation techniques may lead to less blood loss and to radiographic outcomes that are comparable to traditional posterior-only approaches. However, the surgical technique carries significant risks that require further evaluation and proper informed consent.
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Comparative Study
Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis.
The object of this study was to evaluate an alternative surgical approach to degenerative thoracolumbar deformity in adults. The authors present their early experience with the minimally invasive, lateral retroperitoneal transpsoas approach for placing interbody grafts and providing anterior column support for adult degenerative deformity. ⋯ Degenerative scoliosis of the adult spine is secondary to asymmetrical degeneration of the discs. Surgical decompression and correction of the deformity can be performed from an anterior, posterior, or combined approach. These procedures are often associated with long operative times and a high incidence of complications. The authors' experience with the minimally invasive, lateral retroperitoneal transpsoas approach for placement of a large interbody graft for anterior column support, restoration of disc height, arthrodesis, and realignment is a feasible alternative to these procedures.
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Comparative Study
Intraoperative computed tomography image-guided navigation for posterior thoracolumbar spinal instrumentation in spinal deformity surgery.
Placement of thoracolumbar pedicle screws in spinal deformity surgery has a reported inaccuracy rate as high as 30%. At present, image-guided navigation systems designed to improve instrumentation accuracy typically use intraoperative fluoroscopy or preoperative CT scans. The authors report the prospective evaluation of the accuracy of posterior thoracolumbar spinal instrumentation using a new intraoperative CT operative suite with an integrated image guidance system. They compare the accuracy of thoracolumbar pedicle screw placement using intraoperative CT image guidance with instrumentation placement utilizing fluoroscopy. ⋯ Intraoperative CT-based image guidance for placement of thoracolumbar instrumentation has an accuracy that exceeds reported rates with other image guidance systems, such as virtual fluoroscopy and 3D isocentric C-arm-based stereotactic systems. Furthermore, with the use of intraoperative CT scanning, a postinstrumentation CT scan allows the surgeon to evaluate the accuracy of instrumentation before wound closure and revise as appropriate.
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Pedicle subtraction osteotomy (PSO) is a powerful technique for correcting a fixed sagittal plane deformity. The authors report the case of a 51-year-old man with a history of multiple prior lumbar operations, flat-back syndrome, thoracic kyphosis, and radiculopathy, who underwent deformity correction surgery with T3-S1 pedicle screw fixation and L-3 PSO. ⋯ The patient subsequently underwent anterior and posterior revision surgery. This case is a rare instance of spondylolisthesis following PSO.