Abstract:
OBJECT:It is hypothesized that minimally invasive surgical techniques lead to fewer complications than open surgery for adult spinal deformity (ASD). The goal of this study was to analyze matched patient cohorts in an attempt to isolate the impact of approach on adverse events. METHODS:Two multicenter databases queried for patients with ASD treated via surgery and at least 1 year of follow-up revealed 280 patients who had undergone minimally invasive surgery (MIS) or a hybrid procedure (HYB; n = 85) or open surgery (OPEN; n = 195). These patients were divided into 3 separate groups based on the approach performed and were propensity matched for age, preoperative sagittal vertebral axis (SVA), number of levels fused posteriorly, and lumbar coronal Cobb angle (CCA) in an attempt to neutralize these patient variables and to make conclusions based on approach only. Inclusion criteria for both databases were similar, and inclusion criteria specific to this study consisted of an age > 45 years, CCA > 20°, 3 or more levels of fusion, and minimum of 1 year of follow-up. Patients in the OPEN group with a thoracic CCA > 75° were excluded to further ensure a more homogeneous patient population. RESULTS:In all, 60 matched patients were available for analysis (MIS = 20, HYB = 20, OPEN = 20). Blood loss was less in the MIS group than in the HYB and OPEN groups, but a significant difference was only found between the MIS and the OPEN group (669 vs 2322 ml, p = 0.001). The MIS and HYB groups had more fused interbody levels (4.5 and 4.1, respectively) than the OPEN group (1.6, p < 0.001). The OPEN group had less operative time than either the MIS or HYB group, but it was only statistically different from the HYB group (367 vs 665 minutes, p < 0.001). There was no significant difference in the duration of hospital stay among the groups. In patients with complete data, the overall complication rate was 45.5% (25 of 55). There was no significant difference in the total complication rate among the MIS, HYB, and OPEN groups (30%, 47%, and 63%, respectively; p = 0.147). No intraoperative complications were reported for the MIS group, 5.3% for the HYB group, and 25% for the OPEN group (p < 0.03). At least one postoperative complication occurred in 30%, 47%, and 50% (p = 0.40) of the MIS, HYB, and OPEN groups, respectively. One major complication occurred in 30%, 47%, and 63% (p = 0.147) of the MIS, HYB, and OPEN groups, respectively. All patients had significant improvement in both the Oswestry Disability Index (ODI) and visual analog scale scores after surgery (p < 0.001), although the MIS group did not have significant improvement in leg pain. The occurrence of complications had no impact on the ODI. CONCLUSIONS:Results in this study suggest that the surgical approach may impact complications. The MIS group had significantly fewer intraoperative complications than did either the HYB or OPEN groups. If the goals of ASD surgery can be achieved, consideration should be given to less invasive techniques.
journal_name
Neurosurg Focusjournal_title
Neurosurgical focusauthors
Uribe JS,Deukmedjian AR,Mummaneni PV,Fu KM,Mundis GM Jr,Okonkwo DO,Kanter AS,Eastlack R,Wang MY,Anand N,Fessler RG,La Marca F,Park P,Lafage V,Deviren V,Bess S,Shaffrey CI,International Spine Study Group.doi
10.3171/2014.3.FOCUS13534subject
Has Abstractpub_date
2014-05-01 00:00:00pages
E15issue
5issn
1092-0684journal_volume
36pub_type
杂志文章abstract::Herpes simplex encephalitis is a common viral encephalitis associated with significant morbidity and mortality if not diagnosed and treated early. Neurosurgery may be an impetus for viral reactivation, either from direct nerve manipulation or high-dose steroids often administered during cases. The authors present the ...
journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/2019.5.FOCUS19281
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVE:Nonfunctioning pituitary adenomas present without biochemical or clinical signs of hormone excess and are the second most common type of pituitary adenomas. The 2017 WHO classification scheme of pituitary adenomas differentiates null-cell adenomas (NCAs) and silent gonadotroph adenomas (SGAs). The present stu...
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journal_title:Neurosurgical focus
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doi:10.3171/2017.5.FOCUS17175
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.10.FocusVid.18259
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abstract:OBJECT:An experimental study was performed to determine the biomechanical end-mounting configurations that replicate in vivo physiological motion of the cervical spine in a multiple-level human cadaveric model. The vertebral motion response for the modified testing protocol was compared to in vivo motion data and tradi...
journal_title:Neurosurgical focus
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abstract::A common surgical complication of clipping aneurysms with a calcified neck is the calcified atheroma compromising the parent arteries after clipping the neck. Clips can slip downward at the calcified neck or cause calcified atheroma encroaching the parent arteries. This video demonstrates a reconstructive clip techniq...
journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2015.7.FocusVid.14615
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journal_title:Neurosurgical focus
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doi:10.3171/2011.9.FOCUS11187
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journal_title:Neurosurgical focus
pub_type: 杂志文章
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journal_title:Neurosurgical focus
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
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doi:10.3171/foc.2006.20.2.10
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journal_title:Neurosurgical focus
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doi:
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2010.11.FOCUS10250
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
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pub_type: 杂志文章,评审
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journal_title:Neurosurgical focus
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doi:
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pub_type: 杂志文章,评审
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2017.12.FOCUS17663
更新日期:2018-03-01 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2017.3.FOCUS16534
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journal_title:Neurosurgical focus
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doi:10.3171/foc.1999.6.6.5
更新日期:1999-06-15 00:00:00
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journal_title:Neurosurgical focus
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doi:10.3171/2018.4.FOCUS18120
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/FOC/2008/24/2/E5
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journal_title:Neurosurgical focus
pub_type: 杂志文章,评审
doi:10.3171/foc.2002.13.2.4
更新日期:2002-08-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/foc.2001.10.1.9
更新日期:2001-01-15 00:00:00
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journal_title:Neurosurgical focus
pub_type: 杂志文章
doi:10.3171/2018.9.FOCUS18381
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