Minimally invasive surgery “safe and effective” treatment for adolescent idiopathic scoliosis

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A minimally invasive surgical approach to spinal surgery is relatively new approach to the treatment of adult scoliosis. Studies have shown positive results in terms of deformity correction and complication rates. Little research has been published, however, on the results of minimally invasive scoliosis surgery to treat adolescent idiopathic scoliosis. A new study published in the Journal of Neurosurgery: Pediatrics has shown the approach to be an “effective and safe alternative” to open surgery for the treatment of Lenke Type 5C adolescent idiopathic scoliosis.

The retrospective database review found patients treated either minimally invasively or openly for adolescent idiopathic scoliosis between November 2012 and January 2014. The database included records of “levels of fusion, density of implants, operation time and estimated blood loss,” of preoperative, postoperative and follow-up coronal and sagittal parameters and of Scoliosis Research Society-22 and complication results. “The accuracy of pedicle screw placement,” the authors write, “was assessed according to postoperative axial computed tomography (CT) images in both groups.”

Forty-five Lenke Type 5C adolescent idiopathic scoliosis patients were included in the study, 30 of whom had received treatment by posterior spinal fusion, and 15 of whom had been treated by minimally invasive surgery using O-arm navigation (Medtronic). Following matching according to baseline characteristics, comparison by the authors found that the minimally invasive surgery group had significantly less estimated blood loss (p<0.001). Also in line with usual minimally invasive results, operative times were significantly longer for this group (p<0.002). There were no obvious differences found between postoperative or final follow-up radiographic parameters.

Additionally, “The evaluation of pain and self-image using the SRS-22 showed significantly higher scores in the minimally invasive scoliosis surgery group (p=0.013 and 0.046, respectively) than in the posterior spinal fusion group.” Pedicle placement accuracy was shown to be high via postoperative CT across the cohort, with “no deep wound infection, pseudarthrosis, additional surgery, implant failure, or neurological complications…recorded in either group”.

The authors concluded that scoliosis surgery via a minimally invasive method is “an effective and safe alternative” for patients with this indication, due to comparative radiographic parameters to open surgery, as well as reduced morbidity. Welcoming further study minimally invasive scoliosis, the authors caution that “long-term data are needed” before they could recommend the procedure.