Neurospine Search

CLOSE


Neurospine > Volume 15(1); 2018 > Article
Bae and Lee: Minimally Invasive Spinal Surgery for Adult Spinal Deformity

Abstract

The purpose of this review is to present the current techniques and outcomes of adult spine deformity (ASD) surgery using the minimally invasive spine surgery (MISS) approach. We performed a systemic search of PubMed for literature published through January 2018 with the following terms: “minimally invasive spine surgery,” “adult spinal deformity,” and “degenerative scoliosis.” Of the 138 items that were found through this search, 57 English-language articles were selected for full-text review. According to the severity of the deformity and the symptoms, various types of MISS have been utilized, such as MISS decompression, circumferential MISS, and hybrid surgery. With proper indications, the MISS approach achieved satisfactory clinical and radiological outcomes for ASD, with reduced complication rates. Future studies should aim to define clear indications for the application of various surgical options.

INTRODUCTION

Adult spinal deformity (ASD) requires various surgical endeavor to achieve neural decompression and correction of segmental and global balance. However, ASD often related to high risk of perioperative morbidity due to its extensive surgical field. Minimally invasive spinal surgery (MISS) has been widely adopted for degenerative spine surgery because of little muscle trauma and reduced blood loss. In this respect, MISS has been attempted to adopt for the correction of ASD. The purpose of this study is to provide a comprehensive review of current literature about MISS for ASD.

MATERIALS AND METHODS

We performed a systemic search of PubMed for literature published up to January 2018 with the following terms: “minimally invasive spine surgery” and “adult spinal deformity” and “degenerative scoliosis.” Of the 138 searched, case reports and articles that did not focus on ASD were excluded. After extraction, 57 English articles were selected for full-text review.

INDICATIONS

Although MISS techniques have recently gained in popularity to decrease surgical morbidity after open surgery, there are definitely limitations especially restoring severe sagittal malalignment patients. Selecting proper patients is a key to get a successful outcome. The main goals for the treatment of ASD are adequate neural decompression, restoring or maintaining sagittal and coronal balance and achieving bone union. Mummaneni et al. [1] suggested an algorithm for minimally invasive spinal deformity surgery. Based on preoperative radiological parameters, patients were stratified into different surgical strategies, ranging from MISS decompression only or selective fusion to open surgery with osteotomies. MISS technique is frequently utilized for patients with smaller coronal deformities, a sagittal vertical axis under 6 cm, a baseline pelvic incidence – lumbar lordosis mismatch under 30°, and a pelvic tilt of under 25° [2].

SURGICAL TECHNIQUE

For patients with symptoms of central and lateral recess stenosis or foraminal stenosis accompanying mild spinal deformity, neural decompression is a treatment goal. MISS decompression technique can be utilized for theses patients. Decompression using tubular retraction system or 1-level MISS fusion may be a treatment option [1]. Circumferential MISS (cMISS) technique is composed of 360° deformity correction with anterior interbody support and posterior instrumentation through MISS approach (Fig. 1) [3-7]. Lateral lumbar interbody fusion (LLIF) followed by percutaneous pedicle screw fixation with additional lumbosacral interbody fusion by transforaminal lumbar interbody fusion (TLIF) gets most popularity in cMISS. The hybrid approach includes multilevel LLIF and posterior open instrumentation with or without osteotomies (Fig. 2) [6,8-13]. It is different from cMISS in terms of paraspinal muscle dissection. In ASD with moderate sagittal deformity, a hybrid surgical approach involving a combination of MISS interbody fusion and open posterior approach has been used in the alternation of traditional open posterior-only approach [9,10].
Wang et al. [14] reported tissue-sparing mini-open pedicle subtraction osteotomy for severe ASD, which is technically feasible but has not got a popularity.

LATERAL LUMBAR INTERBODY FUSION

For ASD, LLIF is powerful correction method in both coronal and sagittal plane deformity. The lateral transpsoas approach is direct lateral approach via splitting psoas muscle, whereas the oblique anterior-psoas approach is oblique lateral approach anterior to the psoas muscle. Both approaches is a retroperitoneal approach to the disc space via lateral annulus allowing for discectomy, distraction, and interbody fusion [15]. LLIF can restore intervertebral disc height resulting in indirect decompression of neural foramina without jeopardizing segmental stability because it retains the anterior longitudinal ligament (ALL) and posterior longitudinal ligament [11,16-19]. Furthermore, wide interbody cages that support the lateral rims of the endplate can be placed via the lateral approach, which may translate into prevention of subsidence and subsequent loss of deformity correction. In this respect, degenerative scoliosis is a main indication of LLIF. Many authors reported successful radiological and clinical outcome following LLIF and posterior instrumentation for indirect decompression and realignment of coronal balance [16,17,20-23]. However, the effects on sagittal balance and spinopelvic parameters are often reported to be limited. Anand et al. [24] presented long-term follow-up results of MISS technique for adult scoliosis. They did LLIF followed by the posterior instrumentation and fusion with axial lumbar interbody fusion for coronal deformity without sagittal malalignment. The mean preoperative Cobb angle was 24°, which corrected to 9.5°. The mean preoperative Coronal balance was 25.5 mm, which corrected to 11 mm. The mean preoperative sagittal balance was 31.7 mm and corrected to 10.7 mm. At 2- to 5-year follow-up, they reported comparable correction of ASD significantly improved functional outcomes, and excellent clinical and radiological improvement, but considerably lowers morbidity and complication rates. Although some authors reported improvement of sagittal spinopelvic parameters, most of the patients exhibited main coronal plane deformity without sagittal imbalance or with mild sagittal imbalance due to severe sagittal imbalance is not adequately treated with MISS approach [25,26]. Anterior column realignment (ACR) is a technique for correction of sagittal plane deformity, which is performed via lateral transpsoas approach with ALL release and hyperlordotic cage placement [27]. Recent reports of minimally invasive ACR technique showed successful correction of both regional and global sagittal parameters [27-32]. A single level ACR restored around 30° of lordosis which is comparable with a pedicle substraction osteotomy and 10° of reduction in the pelvic tilt [28,29].

LUMBOSACRAL INTERBODY FUSION OPTION

MISS TLIF is often used as an adjunct to multilevel LLIF or MISS posterior approaches for ASD. Wang [33] reported significant improvement of sagittal balance with multilevel facet osteotomies and MISS TLIF in addition to percutaneous screw fixation for ASD. Anterior lumbar interbody fusion (ALIF) offers several advantages over LLIF, including direct decompression of neural foramina, accessibility to L5–S1, less mobilization of the psoas muscle, resection of the ALL, wide discectomies, and insertion of wedge-shaped lordotic grafts that result in greater segmental lordosis restoration in the lower lumbar spine compared with TLIF [10,34]. However, it does carry the risks related to mobilization of the abdominal viscera and large vessels. Anand and Baron [35] reported a presacral approach for discectomy and interbody fusion with low risk of surgical morbidity. However, supporting literature for this technique for ASD is not sufficient.

PERCUTANEOUS PEDICLE SCREW AND ROD PLACEMENT

Although some selected patients are benefitable for standalone LLIF without posterior instrumtation [36], most of ASD patients need to be stabilized and further corrected by posteriorly with pedicle screw instrumentations. Percutaneous pedicle screw instrumentation is important for the cMISS deformity surgery. Various correction maneuvers including vertical translation of apex, rebalancing of both coronal and sagittal plane with compression, distraction, and direct derotation are applicable following LLIF [35,37,38]. For rigid lumbosacral fixation in cMISS, Wang et al. [39] reported feasibility and safety of percutaneous iliac screws placement without extensive muscle exposure. Fluoroscopic guidance is essential and recent advances for image-guided surgery with navigation or robotic guidance enhance safety and accuracy of the surgery [40,41].

OUTCOMES AND COMPLICATIONS

Ever since Dakwar et al. [42] reported the feasibility of LLIF for adult degenerative scoliosis, for properly indicated patients, MISS approach achieved good clinical and radiological outcomes. Anand et al. [4] reported mean 48-month follow-up results after cMISS for moderate (Cobb angle between 30° and 75°) adult scoliosis. Mean Cobb angle and sagittal vertical axis was decreased from 42° and 51 mm preoperatively to 16° and 27 mm postoperatively. Health-related quality of life (HRQoL) scores were also improved at last follow-up with considerable lower morbidity and complication rates. However, cMISS procedure had the limitation of correction in both coronal and sagittal plane deformity [6,11,25,26,43,44]. Careful decision making for choosing surgical approach is mandatory in tailoring goals of deformity correction according to patients’ radiological and clinical status. For similar baseline deformity, cMISS exhibits reduced construct length, reoperation rate, costs, blood loss, and hospital stays with comparable clinical radiological improvement [7,45-54]. Uribe et al. [7] reported significant decreased in mean fusion levels (4.8 for cMISS vs. 10.1 open), blood loss (488 mL cMISS vs. 1,762 mL open) and hospital stay (6.7 days cMISS vs. 9.7 days open) in cMISS. Due to decreased surgery-related morbidity, older patients can have benefit after MISS approach for ASD in terms of HRQoL improvement [55]. Major complications such as massive bleeding and postsurgical infection rate is relatively less in cMISS than in open surgery. However, a complication related to surgical approach especially for LLIF should be considered. Iliopsoas weakness, temporary paresthesia, dysesthesia or numbness on thigh has been reported ranging 12.5% to 75% with LLIF [18,56]. Pseudarthrosis is a major issue for long-term outcome after ASD surgery. Fusion rate after cMISS surgery widely ranges from 71.4% to 100%, while overall fusion rate after ASD surgery is reported to be 93.7% (range, 59%–100%) [57,58]. Use of bone graft substitute such as recombinant human bone morphogenetic protein-2 helps to enhance fusion rate [59]. Mummaneni et al. [60] showed the pseudarthrosis is higher in cMISS compared with hybrid group (46.% vs. 71.6%) and overall incidence of proximal junctional kyphosis (PJK) (48.1% vs. 53.8%) and reoperation for PJK (11.1% vs. 19.2%) is similar in cMISS and hybrid group. Bae et al. [10] showed hybrid surgery utilizing LLIF had lower rates of PJK and mechanical failure at the upper instrumented vertebra and better HRQoL scores in comparison with open posterior surgery and hybrid surgery using ALIF, while radiological improvement was similar between 3 different surgeries for ASD with moderate sagittal imbalance. In comparison with open posterior surgery, Hybrid surgery with LLIF showed faster recovery, fewer complications and greater relief of pain and disability [9].

CONCLUSION

Satisfactory radiological and clinical outcomes can be achieved with MISS approach for ASD. Although MISS correction of deformity is not widely adoptable as open surgery, selecting a proper approach for the specific type of deformity has produced repeatable and safe results. Given currently published literature, efficacy, and limitations of MISS approach is clear. Surgeons should understand roles of various types of surgery to gain goals of deformity correction as well as reducing complications. Due to a wide range of demographic characteristics, pros and cons between different type and the combination of MISS approach are not well demonstrated. Further studies should aim to define better indications of the developing techniques.

CONFLICT OF INTEREST

The authors have nothing to disclose.

Fig. 1.
Case presentation of circumferential minimally invasive surgery for degenerative scoliosis. Preoperative anteriorposterior (A) and lateral (B) radiographs shows coronal plane deformity on lumbar spine. Lateral lumbar interbody fusion at the L1–2, L2–3, L3–4, and L4–5 followed by percutaneous pedicle screw instrumentation successfully restored coronal balance as well as the lordotic curvature of the lumbar spine (C, D).
ns-1836022-011f1.tif
Fig. 2.
Case presentation of hybrid surgery for degenerative kyphoscoliosis. Preoperative anteriorposterior (A) and lateral (B) radiographs shows rigid deformity on both coronal and sagittal plane. Lateral lumbar interbody fusion from L1 to L4 and anterior lumbar interbody fusion from L4 to S1 was performed to restore anterior disc height. Additionally, open posterior segmental instrumentation from T10 to iliac fixation with multilevel grade 2 osteotomies was done to release posterior column mobility and further correction. Postperative anteriorposterior (C) and lateral (D) radiographs shows well balanced coronal and sagittal curvature.
ns-1836022-011f2.tif

REFERENCES

1. Mummaneni PV, Shaffrey CI, Lenke LG, et al. The minimally invasive spinal deformity surgery algorithm: a reproducible rational framework for decision making in minimally invasive spinal deformity surgery. Neurosurg Focus 2014;36:E6.
crossref
2. Eastlack RK, Mundis GM Jr, Wang M, et al. Is there a patient profile that characterizes a patient with adult spinal deformity as a candidate for minimally invasive surgery? Global Spine J 2017;7:703-8.
crossref pmid pmc
3. Kanter AS, Tempel ZJ, Ozpinar A, et al. A review of minimally invasive procedures for the treatment of adult spinal deformity. Spine (Phila Pa 1976) 2016;41 Suppl 8:S59-65.
crossref pmid
4. Anand N, Baron EM, Khandehroo B. Is circumferential minimally invasive surgery effective in the treatment of moderate adult idiopathic scoliosis? Clin Orthop Relat Res 2014;472:1762-8.
crossref pmid pmc
5. Anand N, Kong C, Fessler RG. A staged protocol for circumferential minimally invasive surgical correction of adult spinal deformity. Neurosurgery 2017;81:733-9.
crossref pmid pdf
6. Park P, Wang MY, Lafage V, et al. Comparison of two minimally invasive surgery strategies to treat adult spinal deformity. J Neurosurg Spine 2015;22:374-80.
crossref pmid
7. Uribe JS, Beckman J, Mummaneni PV, et al. Does MIS surgery allow for shorter constructs in the surgical treatment of adult spinal deformity? Neurosurgery 2017;80:489-97.
crossref pmid pdf
8. Barone G, Scaramuzzo L, Zagra A, et al. Adult spinal deformity: effectiveness of interbody lordotic cages to restore disc angle and spino-pelvic parameters through completely miniinvasive trans-psoas and hybrid approach. Eur Spine J 2017;26(Suppl 4):457-63.
crossref pmid pdf
9. Strom RG, Bae J, Mizutani J, et al. Lateral interbody fusion combined with open posterior surgery for adult spinal deformity. J Neurosurg Spine 2016;25:697-705.
crossref pmid
10. Bae J, Theologis AA, Strom R, et al. Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance. J Neurosurg Spine 2018;28:40-9.
crossref pmid
11. Haque RM, Mundis GM Jr, Ahmed Y, et al. Comparison of radiographic results after minimally invasive, hybrid, and open surgery for adult spinal deformity: a multicenter study of 184 patients. Neurosurg Focus 2014;36:E13.
crossref
12. Theologis AA, Mundis GM Jr, Nguyen S, et al. Utility of multilevel lateral interbody fusion of the thoracolumbar coronal curve apex in adult deformity surgery in combination with open posterior instrumentation and L5-S1 interbody fusion: a case-matched evaluation of 32 patients. J Neurosurg Spine 2017;26:208-19.
crossref pmid
13. Tempel ZJ, Gandhoke GS, Bonfield CM, et al. Radiographic and clinical outcomes following combined lateral lumbar interbody fusion and posterior segmental stabilization in patients with adult degenerative scoliosis. Neurosurg Focus 2014;36:E11.
crossref pmc
14. Wang MY, Bordon G. Mini-open pedicle subtraction osteotomy as a treatment for severe adult spinal deformities: case series with initial clinical and radiographic outcomes. J Neurosurg Spine 2016;24:769-76.
crossref pmid
15. Liu G, Liu S, Zuo YZ, et al. Recent advances in technique and clinical outcomes of minimally invasive spine surgery in adult scoliosis. Chin Med J (Engl) 2017;130:2608-15.
crossref pmid pmc
16. Caputo AM, Michael KW, Chapman TM, et al. Extreme lateral interbody fusion for the treatment of adult degenerative scoliosis. J Clin Neurosci 2013;20:1558-63.
crossref pmid
17. Dahdaleh NS, Smith ZA, Snyder LA, et al. Lateral transpsoas lumbar interbody fusion: outcomes and deformity correction. Neurosurg Clin N Am 2014;25:353-60.
crossref pmid
18. Mundis GM, Akbarnia BA, Phillips FM. Adult deformity correction through minimally invasive lateral approach techniques. Spine (Phila Pa 1976) 2010;35(26 Suppl):S312-21.
crossref pmid
19. Isaacs RE, Hyde J, Goodrich JA, et al. A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine (Phila Pa 1976) 2010;35(26 Suppl):S322-30.
crossref pmid
20. Abbasi H, Miller L, Abbasi A, et al. Minimally invasive scoliosis surgery with oblique lateral lumbar interbody fusion: single surgeon feasibility study. Cureus 2017;9:e1389.
crossref pmid pmc
21. Berjano P, Lamartina C. Far lateral approaches (XLIF) in adult scoliosis. Eur Spine J 2013;22 Suppl 2:S242-53.
crossref pmid
22. Deukmedjian AR, Ahmadian A, Bach K, et al. Minimally invasive lateral approach for adult degenerative scoliosis: lessons learned. Neurosurg Focus 2013;35:E4.
crossref
23. Scheer JK, Khanna R, Lopez AJ, et al. The concave versus convex approach for minimally invasive lateral lumbar interbody fusion for thoracolumbar degenerative scoliosis. J Clin Neurosci 2015;22:1588-93.
crossref pmid
24. Anand N, Baron EM, Khandehroo B, et al. Long-term 2- to 5-year clinical and functional outcomes of minimally invasive surgery for adult scoliosis. Spine (Phila Pa 1976) 2013;38:1566-75.
crossref pmid
25. Costanzo G, Zoccali C, Maykowski P, et al. The role of minimally invasive lateral lumbar interbody fusion in sagittal balance correction and spinal deformity. Eur Spine J 2014;23 Suppl 6:699-704.
crossref pmid
26. Mundis GM Jr, Turner JD, Deverin V, et al. A critical analysis of sagittal plane deformity correction with minimally invasive adult spinal deformity surgery: a 2-year follow-up study. Spine Deform 2017;5:265-71.
crossref pmid
27. Deukmedjian AR, Dakwar E, Ahmadian A, et al. Early outcomes of minimally invasive anterior longitudinal ligament release for correction of sagittal imbalance in patients with adult spinal deformity. ScientificWorldJournal 2012;2012:789698.
crossref pmid pmc pdf
28. Berjano P, Cecchinato R, Sinigaglia A, et al. Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study. Eur Spine J 2015;24 Suppl 3:433-8.
crossref pmid
29. Leveque JC, Yanamadala V, Buchlak QD, et al. Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy. Neurosurg Focus 2017;43:E15.
crossref
30. Mundis GM Jr, Turner JD, Kabirian N, et al. anterior column realignment has similar results to pedicle subtraction osteotomy in treating adults with sagittal plane deformity. World Neurosurg 2017;105:249-56.
crossref pmid
31. Saigal R, Mundis GM Jr, Eastlack R, et al. Anterior column realignment (ACR) in adult sagittal deformity correction: technique and review of the literature. Spine (Phila Pa 1976) 2016;41 Suppl 8:S66-73.
crossref pmid
32. Turner JD, Akbarnia BA, Eastlack RK, et al. Radiographic outcomes of anterior column realignment for adult sagittal plane deformity: a multicenter analysis. Eur Spine J 2015;24 Suppl 3:427-32.
crossref pmid
33. Wang MY. Improvement of sagittal balance and lumbar lordosis following less invasive adult spinal deformity surgery with expandable cages and percutaneous instrumentation. J Neurosurg Spine 2013;18:4-12.
crossref pmid
34. Dorward IG, Lenke LG, Bridwell KH, et al. Transforaminal versus anterior lumbar interbody fusion in long deformity constructs: a matched cohort analysis. Spine (Phila Pa 1976) 2013;38:E755-62.
crossref pmid
35. Anand N, Baron EM. Minimally invasive approaches for the correction of adult spinal deformity. Eur Spine J 2013;22 Suppl 2:S232-41.
crossref pmid
36. Ahmadian A, Bach K, Bolinger B, et al. Stand-alone minimally invasive lateral lumbar interbody fusion: multicenter clinical outcomes. J Clin Neurosci 2015;22:740-6.
crossref pmid
37. Anand N, Baron EM, Thaiyananthan G, et al. Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis: a technique and feasibility study. J Spinal Disord Tech 2008;21:459-67.
crossref pmid
38. Roldan H, Perez-Orribo L, Spreafico M, et al. Long constructs in the thoracic and lumbar spine with a minimally invasive technique. Minim Invasive Neurosurg 2011;54:100-3.
crossref pmid pdf
39. Wang MY, Williams S, Mummaneni PV, et al. Minimally invasive percutaneous iliac screws: initial 24 case experiences with CT confirmation. Clin Spine Surg 2016;29:E222-5.
crossref pmid
40. Ahmad FU, Wang MY. Use of anteroposterior view fluoroscopy for targeting percutaneous pedicle screws in cases of spinal deformity with axial rotation. J Neurosurg Spine 2014;21:826-32.
crossref pmid
41. Hyun SJ, Kim KJ, Jahng TA. S2 alar iliac screw placement under robotic guidance for adult spinal deformity patients: technical note. Eur Spine J 2017;26:2198-203.
crossref pmid pdf
42. Dakwar E, Cardona RF, Smith DA, et al. Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus 2010;28:E8.
crossref
43. Uribe JS, Januszewski J, Wang M, et al. Patients with high pelvic tilt achieve the same clinical success as those with low pelvic tilt after minimally invasive adult deformity surgery. Neurosurgery 2017;Aug 17 [Epub]. https://doi.org/10.1093/neuros/nyx383.
crossref pdf
44. Wang MY, Mummaneni PV, Fu KM, et al. Less invasive surgery for treating adult spinal deformities: ceiling effects for deformity correction with 3 different techniques. Neurosurg Focus 2014;36:E12.
crossref
45. Uddin OM, Haque R, Sugrue PA, et al. Cost minimization in treatment of adult degenerative scoliosis. J Neurosurg Spine 2015;23:798-806.
crossref pmid
46. Wang MY, Mummaneni PV. Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes. Neurosurg Focus 2010;28:E9.
crossref
47. Anand N, Sardar ZM, Simmonds A, et al. Thirty-day reoperation and readmission rates after correction of adult spinal deformity via circumferential minimally invasive surgeryanalysis of a 7-year experience. Spine Deform 2016;4:78-83.
crossref pmid
48. Hamilton DK, Kanter AS, Bolinger BD, et al. Reoperation rates in minimally invasive, hybrid and open surgical treatment for adult spinal deformity with minimum 2-year follow-up. Eur Spine J 2016;25:2605-11.
crossref pmid pdf
49. Than KD, Mummaneni PV, Bridges KJ, et al. omplication rates associated with open versus percutaneous pedicle screw instrumentation among patients undergoing minimally invasive interbody fusion for adult spinal deformity. Neurosurg Focus 2017;43:E7.
crossref
50. Than KD, Nguyen S, Park P, et al. 165 What is the effect of open vs percutaneous screws on complications among patients undergoing lateral interbody fusion for adult spinal deformity? Neurosurgery 2016;63 Suppl 1:166.
crossref pdf
51. Than KD, Park P, Fu KM, et al. Clinical and radiographic parameters associated with best versus worst clinical outcomes in minimally invasive spinal deformity surgery. J Neurosurg Spine 2016;25:21-5.
crossref pmid
52. Uribe JS, Deukmedjian AR. Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review. Eur Spine J 2015;24 Suppl 3:386-96.
crossref pmid
53. Uribe JS, Deukmedjian AR, Mummaneni PV, et al. Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques. Neurosurg Focus 2014;36:E15.
crossref
54. Yen CP, Mosley YI, Uribe JS. Role of minimally invasive surgery for adult spinal deformity in preventing complications. Curr Rev Musculoskelet Med 2016;9:309-15.
crossref pmid pmc pdf
55. Park P, Okonkwo DO, Nguyen S, et al. Can a minimal clinically important difference be achieved in elderly patients with adult spinal deformity who undergo minimally invasive spinal surgery? World Neurosurg 2016;86:168-72.
crossref pmid
56. Murray G, Beckman J, Bach K, et al. Complications and neurological deficits following minimally invasive anterior column release for adult spinal deformity: a retrospective study. Eur Spine J 2015;24 Suppl 3:397-404.
crossref pmid
57. Bach K, Ahmadian A, Deukmedjian A, et al. Minimally invasive surgical techniques in adult degenerative spinal deformity: a systematic review. Clin Orthop Relat Res 2014;472:1749-61.
crossref pmid pmc
58. How NE, Street JT, Dvorak MF, et al. Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors. Neurosurg Rev 2018;Feb 6 [Epub]. https://doi.org/10.1007/s10143-018-0951-3.
crossref pdf
59. Poorman GW, Jalai CM, Boniello A, et al. Bone morphogenetic protein in adult spinal deformity surgery: a meta-analysis. Eur Spine J 2017;26:2094-102.
crossref pmid pdf
60. Mummaneni PV, Park P, Fu KM, et al. Does Minimally invasive percutaneous posterior instrumentation reduce risk of proximal junctional kyphosis in adult spinal deformity surgery? A propensity-matched cohort analysis. Neurosurgery 2016;78:101-8.
crossref pmid pdf


Editorial Office
Department of Neurosurgery, Yonsei University College of Medicine
50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2-2228-2172  E-mail: theneurospine@gmail.com
The Korean Spinal Neurosurgery Society
#407, Dong-A Villate 2nd Town, 350 Seocho-daero, Seocho-gu, Seoul 06631, Korea
Tel: +82-2-585-5455  Fax: +82-2-2-523-6812  E-mail: ksns1987@gmail.com
Business License No.: 209-82-62443

Copyright © The Korean Spinal Neurosurgery Society. All rights reserved.

Developed in M2community

Close layer
prev next