474 - Comparison of Percutaneous vs. Open Instrumentation for Spinal Deformi...

Oral Posters: MIS

Presented by: G. Anderson - View Audio/Video Presentation (Members Only)

Author(s):

D. Mazzaferro(1,2), A. Vaccaro(1), D.G. Anderson(1)

(1) Rothman Institute, Thomas Jefferson University, Philadelphia, PA, United States
(2) Drexel University College of Medicine, Philadelphia, PA, United States

Abstract

Introduction: Although minimally invasive surgery (MIS) has become increasingly popular for lumbar degenerative conditions, there is still a paucity of information on the benefits of percutaneous instrumentation in the setting of spinal deformity surgery. In the current study, we reviewed a series of spinal deformity cases treated by either percutaneous or open spinal instrumentation following anterior lumbar interbody fusion at multiple levels. We compared surgical variables including operative time, blood loss, hospital length of stay, perioperative complications, surgical site infection (SSI) and fusion rate between the two patient cohorts.

Methods: Adult subjects between 40 and 80 years of age, treated at a single institution by two experienced spinal surgeons using a circumferential technique for a thoracolumbar spinal deformity over a 3 year period were evaluated. Patients with incomplete medical records, missing radiographic studies or a history of prior thoracolumbar surgery were excluded. Data was collected by reviewing the medical records and radiographic studies of the subjects. Surgical variables were compared between the groups using the Wilcoxon rank sum and Fisher's exact test.

Results: The study included 48 subjects, 15 following percutaneous and 33 following open instrumentation. The mean age of patients was 59.4 and 60.5 years respectively. Significant differences were found between the cohorts for blood loss (283.33 ± 296.2 mL vs. 1,113.64 ± 938.78 mL, p=0.0001) and surgical time (348.07 ± 140.5 minutes vs. 411.09 ± 113.67 minutes, p=0.036). The length of hospitalization demonstrated a trend towards shorter stay with the percutaneous cohort (4.08 ± 1.19 days vs. 5.00 ± 1.41 days, p=0.071). Deformity correction in the coronal plane was similar in both groups (49.4% vs. 52.7%; p=0.633). The percent of patients who achieved the sagittal balance goal of lumbar lordosis within 10 degrees of the pelvic incidence was similar in both groups (60% vs 63.6%, p=0.809). In the open cohort, there were three major complications: two patients with a surgical site infection requiring irrigation and debridement and one patient with a neurologic deficit requiring revision surgery. In the MIS sample no major complications occurred.

Conclusions: This study suggests that percutaneous instrumentation following anterior lumbar interbody fusion for the treatment of selected adult spinal deformity cases can achieve favorable results that are comparable to open surgery with a lower rate of blood loss and a reduced rate of perioperative complications. Further study of percutaneous instrumentation in the treatment of adult spinal deformity surgery is warranted.