Neurosurg Focus
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Comparative Study
Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome.
A variety of anterior, posterior, and combined approaches exist to decompress the spinal cord, restore sagittal alignment, and avoid kyphosis, but the optimal surgical strategy remains controversial. The authors compared the anterior and posterior approach used to treat multilevel cervical spondylotic myelopathy (CSM), focusing on sagittal alignment and clinical outcome. ⋯ These results demonstrate that both anterior and posterior decompression (with instrumentation) are effective procedures to improve the neurological outcome of patients with CSM. However, sagittal alignment may be better restored using the anterior approach, but harbors a higher rate of loss of correction. In cases involving a preexisting cervical kyphosis, an anterior or combined approach might be necessary to restore the lordotic cervical alignment.
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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
Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes.
Adult degenerative scoliosis can be a cause of intractable pain, decreased mobility, and reduced quality of life. Surgical correction of this problem frequently leads to substantial clinical improvement, but advanced age, medical comorbidities, osteoporosis, and the rigidity of the spine result in high surgical complication rates. Minimally invasive surgery is being applied to this patient population in an effort to reduce the high complication rates associated with adult deformity surgery. ⋯ The minimally invasive surgical treatment of adult deformities is a promising method for reducing surgical morbidity. Numerous challenges exist, as the surgical technique does not yet allow for all correction maneuvers used in open surgery. However, as the techniques are advanced, the applicability of minimally invasive surgery for this population will likely be expanded and will afford the opportunity for reduced complications.
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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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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.