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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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논문 기본 정보

자료유형
학술저널
저자정보
Bo Li (Department of Neurosurgery University of California San Francisco) Gregory Hawryluk (Department of Neurosurgery University of California San Francisco) Praveen V. Mummaneni (Department of Neurosurgery University of California San Francisco) Michael Wang (Department of Neurosurgery University of Miami) Ratnesh Mehra (Department of Neurosurgery University of California San Francisco) Minghao Wang (Department of Neurosurgery University of California San Francisco) Darryl Lau (Department of Neurosurgery University of California San Francisco) Rory Mayer (Department of Neurosurgery University of California San Francisco) Kai-Ming Fu (Department of Neurosurgery Weill Cornell Medical College) Dean Chou (Department of Neurosurgery University of California San Francisco)
저널정보
대한척추신경외과학회 Neurospine Neurospine 제18권 제4호
발행연도
2021.12
수록면
824 - 832 (9page)
DOI
10.14245/ns.2142508.254

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Objective: Long-segment fusion in adult spinal deformity (ASD) is often needed, but more focal surgeries may provide significant relief with less morbidity. The minimally invasive spinal deformity surgery (MISDEF2) algorithm guides minimally invasive ASD surgery, but it may be useful in open ASD surgery. We classified ASD patients undergoing focal decompression, limited decompression and fusion, and full correction according to MISDEF2 and correlated outcomes. Methods: A retrospective study of ASD patients treated by 2 surgeons at our hospital was performed. Inclusion criteria were: age >50, minimum 2-year follow-up, and open ASD surgery. Tumor, trauma, and infections were excluded. Patients had open surgery including focal decompression, short segment fusion, or full scoliosis correction. All patients were categorized by MISDEF2 into 4 classes based upon spinopelvic parameters. Perioperative metrics were assessed. Radiographic correction, complications and reoperation were recorded. Results: A total of 136 patients met inclusion criteria. Mean follow-up was 46±15.8 months (range, 24?118 months). Forty-seven underwent full deformity correction, 71 underwent short segment fusion, and 18 underwent decompression alone. There were 24 cases of class I, 66 cases of class II, 23 cases of class III, and 23 cases of class IV patients. Patients in class I and II had perioperative complication rates of 0% and 16.7% and revision rates of 8% and 21.2% when undergoing focal decompression or limited fusion. However, class II patients undergoing full correction had higher perioperative complications rate (p=0.03) and revision surgery rates (p=0.047). This difference was not seen in class III patients (p>0.05). All class IV patients underwent full correction, but they had higher perioperative complication rates (p<0.019), comparable revision surgery rates (p=0.27), and better radiographic realignment (p<0.001). In addition, full deformity correction was associated with longer length of stay, increased blood loss, and longer operative time (p<0.001). Conclusion: The MISDEF2 algorithm may help guide ASD surgical decision making even in open surgery, with focal treatment used in class I and II patients as a viable alternative and full correction implemented in class IV patients because of severe malalignment. However, class II patients with ASD undergoing full deformity correction do have higher complication rates.
#MISDEF2 #Adult spinal deformity #Adult spinal deformity #Minimally invasive surgery #Complications #Outcomes

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참고문헌 (20)

참고문헌 신청
Marchesi DG / 1992 / Pedicle fixation devices in the treatment of adult lumbar scoliosis / Spine 17(8 Suppl):S304~S309 google schola Tribus CB / 2003 / Degenerative lumbar scoliosis : evaluation and management / J Am Acad Orthop Surg 11:174~183 google schola Cho KJ / 2008 / Short fusion versus long fusion for degenerative lumbar scoliosis / Eur Spine J 17:650~656 google schola Houten JK / 2013 / Symptomatic progression of degenerative scoliosis after decompression and limited fusion surgery for lumbar spinal stenosis / J Clin Neurosci 20:613~615 google schola Transfeldt EE / 2010 / Surgical outcomes of decompression, decompression with limited fusion, and decompression with full curve fusion for degenerative scoliosis with radiculopathy / Spine 35:1872~1875 google schola

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