What is the Effect of Open vs Percutaneous Screws on Complications Among Patients Undergoing Lateral Interbody Fusion for Adult Spinal Deformity?

Presented at SMISS Annual Forum 2016
By Paul Park MD
With Juan Uribe MD, FACS, Neel Anand MD, Robert Eastlack MD, Praveen Mummaneni MD, Adam Kanter MD, Frank LaMarca MD, International Group , Dean Chou MD, Gregory Mundis MD, Pierce Nunley MD, Stacie Nguyen MPH, Khoi Than MD, Todd Vogel MD,

Disclosures: Paul Park MD B; Biomet, Globus, Medtronic, Nuvasive. F; Globus Juan Uribe MD, FACS A; Nuvasive. B; Nuvasive. C; Nuvasive. D; Nuvasive. F; Nuvasive, Neel Anand MD None, Robert Eastlack MD None, Praveen Mummaneni MD B; Globus, Adam Kanter MD None, Frank LaMarca MD A; NIH, NREF, Globus, DePuy Synthes Spine. B; Biomet, Lanx, Globus. F; Globus, Stryker., International Group A; Biomet, Depuy, Innovasis, K2M, Medtronic, Nuvasive, Stryker., Dean Chou MD None, Gregory Mundis MD A; ISSGF, Nuvasive. B; K2M, Medicrea, Misonix, Nuvasive. C; K2M, Nuvasive. F; Nuvasive., Pierce Nunley MD None, Stacie Nguyen MPH None, Khoi Than MD None, Todd Vogel MD None,


In a multicenter retrospective review of an adult spinal deformity database, it was determined that patients who underwent circumferential MIS surgery had fewer minor, neurologic, and operative complications than patients who underwent hybrid surgery. 


This study aims to compare differences in incidence and type of complications (COMP) between circumferential MIS (cMIS, i.e. MIS TLIF and/or LLIF with MIS screws) and hybrid approaches (HYB, i.e. MIS LLIF +/- with open screws). 


A retrospective review of a multicenter MIS deformity database was performed. Inclusion criteria for this database: age>18 years, and at least one of the following: coronal Cobb angle (CCA)>20, SVA>5cm, PI-LL>10 and PT> 20. Only patients who underwent cMIS or HYB approaches were included for this study, and were propensity matched by levels instrumented. 


Of 420 patients that met inclusion criteria, 165 had complete data. 137 were available for analysis after excluding 3 column osteotomies and 76 remained after propensity matching (38 cMIS and 38 HYB). There were no differences in demographics, number of levels instrumented (6.8 HYB vs. 6.1 cMIS; p=0.622), and pre- and post-operative radiographic results. HYB had significantly longer OR time (623 v 490 min; p=0.015) and larger EBL (1396 v 637; p=0.001). 55.3% of HYB vs 44.7% cMIS patients suffered at least one COMP (p=0.359). cMIS patients had significantly fewer neurologic (p=0.044), operative (p=0.005), and minor (p=0.034) COMPs. Reoperation was similar between groups (28.9% HYB, 26.3% cMIS). The most common COMP for cMIS was radiographic (n=10; 6 with pseudoarthrosis) and neurologic for HYB (n=11; 8 with radiculopathy. Both groups saw improvement from pre to post op ODI, VAS back and leg (all p<0.05), however cMIS had a greater reduction in VAS leg (p=0.002). 


The overall COMP rate between cMIS and HYB is similar. CMIS surgery results in significantly fewer neurologic, operative, and minor COMP, Reoperation rates were similar, and despite complications patients saw significant improvement in pain and function.