• World Neurosurg · Jun 2019

    Analysis of complications with staged surgery for less invasive treatment of adult spinal deformity.

    • Khoi D Than, Paul Park, Stacie Tran, Gregory M Mundis, Kai-Ming Fu, Juan S Uribe, David O Okonkwo, Pierce D Nunley, Richard G Fessler, Robert K Eastlack, Adam Kanter, Neel Anand, Frank LaMarca, Peter G Passias, Praveen V Mummaneni, and International Spine Study Group.
    • Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA. Electronic address: thank@ohsu.edu.
    • World Neurosurg. 2019 Jun 1; 126: e1337-e1342.

    BackgroundSpinal deformity surgery is often invasive and lengthy. Staging surgery over separate operative days may reduce complications. Staging is often used in minimally invasive treatment of adult spinal deformity (ASD).ObjectiveTo investigate the impact of staging on complication rates between hybrid (HYB; minimally invasive interbody with open posterior screw and rod fixation) and circumferential minimally invasive surgery (cMIS; minimally invasive interbody and screw/rod placement) procedures in patients with ASD.MethodsA multicenter database of patients with ASD was reviewed. Patients who underwent staging (at least 3 levels) and 2 years of follow-up were analyzed. A total of 99 patients underwent staging: 53 cMIS and 46 HYB surgeries. Propensity matching for levels fused resulted in 19 patients in each group. Intra- and perioperative complications were assessed.ResultsThree HYB but no cMIS intraoperative complications occurred. More HYB patients had perioperative complications than cMIS patients. Neurologic complications were more frequent in HYB versus cMIS. Other complications did not differ significantly. Thirty-day reoperations were higher with cMIS than HYB, but there was no difference in reoperation rate at long-term follow-up. cMIS patients had greater improvement in the Oswestry Disability Index. There was no difference in complications between staged versus unstaged cMIS surgeries.ConclusionscMIS staged surgeries appear safer than HYB staged surgeries, and equally safe to cMIS unstaged surgeries. Perioperative complications were significantly higher for HYB staged surgeries. HYB surgeries may have better results when performed in a single setting, whereas cMIS surgeries can be performed in 1 or 2 stages depending on surgeon preference.Copyright © 2019 Elsevier Inc. All rights reserved.

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