Abstract

While open surgery has been the primary surgical approach for adult degenerative scoliosis, minimally invasive surgery (MIS) represents an alternative option and appears to be associated with reduced morbidity. Given the lack of consensus, we aimed to conduct a systematic review on available literature comparing MIS versus open surgery for adult degenerative scoliosis. PubMed, Embase, and Cochrane databases were searched through December 16, 2019, for studies that compared both MIS and open surgery in patients with degenerative scoliosis. Four cohort studies reporting on 350 patients met the inclusion criteria. In two studies, patients undergoing open surgery were younger and had more severe disease at baseline as compared with MIS. Patients who underwent MIS had less blood loss, shorter length of stay, and a reduced rate of complications and infections. Both MIS and open surgery resulted in a significant change in pain and disability scores and both approaches provided significant correction of deformity in all studies, although open surgery was associated with a greater change in pelvic incidence-lumbar lordosis mismatch (PI-LL) and sagittal vertical axis (SVA) in two and three studies, respectively. In patients with adult degenerative scoliosis undergoing surgery, both MIS and open approaches appeared to offer comparable improvements in pain and function. However, MIS was associated with better safety outcomes, while open surgery provided greater correction of spinal deformity. Further studies are needed to identify specific subset of patients who may benefit from one approach versus the other.

中文翻译：

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微创手术与开放性手术矫正成人变性脊柱侧弯的系统评价

摘要

尽管开放手术已成为成人退行性脊柱侧弯的主要手术方法，但微创手术（MIS）代表了另一种选择，并且似乎与发病率降低相关。鉴于缺乏共识，我们旨在对现有文献对成人退行性脊柱侧凸的MIS与开放手术进行比较，以进行系统回顾。搜寻截至2019年12月16日的PubMed，Embase和Cochrane数据库，以比较退行性脊柱侧弯患者的MIS和开放手术。四项队列研究报告了350名患者，符合纳入标准。在两项研究中，与MIS相比，接受开腹手术的患者更年轻，基线时的病情更重。接受MIS的患者失血少，住院时间短，并降低了并发症和感染的发生率。MIS和开放式手术均会导致疼痛和残疾评分的显着变化，尽管开放式手术与盆腔发生率-腰椎前凸不匹配（PI-LL）和矢状面的较大变化相关，但两种方法均在所有研究中均显着纠正了畸形。垂直轴（SVA）分别在两个和三个研究中。在接受手术的成人退行性脊柱侧弯患者中，MIS和开放式方法似乎在疼痛和功能上均具有可比的改善。然而，MIS与更好的安全性相关，而开放式手术可提供更大的脊柱畸形矫正。需要进一步的研究来确定可能从一种方法相对于另一种方法中受益的特定患者子集。MIS和开放式手术均会导致疼痛和残疾评分的显着变化，尽管开放式手术与盆腔发生率-腰椎前凸不匹配（PI-LL）和矢状面的较大变化相关，但两种方法均在所有研究中均显着纠正了畸形。垂直轴（SVA）分别在两个和三个研究中。在接受手术的成人退行性脊柱侧弯患者中，MIS和开放式方法似乎在疼痛和功能上均具有可比的改善。然而，MIS与更好的安全性相关，而开放式手术可提供更大的脊柱畸形矫正。需要进一步的研究来确定可能从一种方法相对于另一种方法中受益的特定患者子集。MIS和开放式手术均会导致疼痛和残疾评分的显着变化，尽管开放式手术与盆腔发生率-腰椎前凸不匹配（PI-LL）和矢状面的较大变化相关，但两种方法均在所有研究中均显着纠正了畸形。垂直轴（SVA）分别在两个和三个研究中。在接受手术的成人退行性脊柱侧弯患者中，MIS和开放式方法似乎在疼痛和功能上均具有可比的改善。然而，MIS与更好的安全性相关，而开放式手术可提供更大的脊柱畸形矫正。需要进一步的研究来确定可能从一种方法相对于另一种方法中受益的特定患者子集。