Skip to main content

Minimally invasive versus open surgery for the correction of adult degenerative scoliosis: a systematic review

Neurosurgical Review volume 44, pages 659–668 (2021)Cite this article

Abstract

While open surgery has been the primary surgical approach for adult degenerative scoliosis, minimally invasive surgery (MIS) represents an alternative option and appears to be associated with reduced morbidity. Given the lack of consensus, we aimed to conduct a systematic review on available literature comparing MIS versus open surgery for adult degenerative scoliosis. PubMed, Embase, and Cochrane databases were searched through December 16, 2019, for studies that compared both MIS and open surgery in patients with degenerative scoliosis. Four cohort studies reporting on 350 patients met the inclusion criteria. In two studies, patients undergoing open surgery were younger and had more severe disease at baseline as compared with MIS. Patients who underwent MIS had less blood loss, shorter length of stay, and a reduced rate of complications and infections. Both MIS and open surgery resulted in a significant change in pain and disability scores and both approaches provided significant correction of deformity in all studies, although open surgery was associated with a greater change in pelvic incidence-lumbar lordosis mismatch (PI-LL) and sagittal vertical axis (SVA) in two and three studies, respectively. In patients with adult degenerative scoliosis undergoing surgery, both MIS and open approaches appeared to offer comparable improvements in pain and function. However, MIS was associated with better safety outcomes, while open surgery provided greater correction of spinal deformity. Further studies are needed to identify specific subset of patients who may benefit from one approach versus the other.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M, Farcy JP (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976) 30:1082–1085

    Article  Google Scholar 

  2. Adogwa O, Sure DR, LaBagnara M, Shaffrey CI, Fessler RG (2016) Minimally invasive spine surgery and sagittal correction. Neurosurgery 63(Suppl 1):31–36. https://doi.org/10.1227/neu.0000000000001290

    Article  PubMed  Google Scholar 

  3. Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, Boachie-Adjei O, Burton DC, Akbarnia BA, Mundis GM, Ames CP, Kebaish K, Hart RA, Farcy JP, Lafage V (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 38:E803–E812. https://doi.org/10.1097/BRS.0b013e318292b7b9

    Article  Google Scholar 

  4. Blondel B, Schwab F, Ungar B, Smith J, Bridwell K, Glassman S, Shaffrey C, Farcy JP, Lafage V (2012) Impact of magnitude and percentage of global sagittal plane correction on health-related quality of life at 2-years follow-up. Neurosurgery 71:341–348; discussion 348. https://doi.org/10.1227/NEU.0b013e31825d20c0

    Article  PubMed  Google Scholar 

  5. Maggio DAT, Kelleher J, Ames C, Shaffrey C, Smith J (2017) Evaluation and treatment of adult scoliosis and sagittal plane deformity. In: Couldwell WMB, Seifert V, Ture U, Kliot M, Magistretti P (eds) Youmans and Winn neurological surgery, 7th edn. Elsevier Inc, Philadelphia, pp 2594–2602

    Google Scholar 

  6. Chou D, Mundis G, Wang M, Fu KM, Shaffrey C, Okonkwo D, Kanter A, Eastlack R, Nguyen S, Deviren V, Uribe J, Fessler R, Nunley P, Anand N, Park P, Mummaneni P (2019) Minimally invasive surgery for mild to moderate adult spinal deformities: impact on intensive care unit and hospital stay. World Neurosurg 127:e649 01. https://doi.org/10.1016/j.wneu.2019.03.237

    Article  PubMed  Google Scholar 

  7. Uddin OM, Haque R, Sugrue PA, Ahmed YM, El Ahmadieh TY, Press JM, Koski T, Fessler RG (2015) Cost minimization in treatment of adult degenerative scoliosis. J Neurosurg Spine 23:798–806. https://doi.org/10.3171/2015.3.Spine14560

    Article  PubMed  Google Scholar 

  8. 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 (2014) Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques. Neurosurg Focus 36:E15. https://doi.org/10.3171/2014.3.Focus13534

    Article  PubMed  Google Scholar 

  9. Kulkarni A, Bohra H, Dhruv A, Sarraf A, Bassi A, Patil V (2016) Minimal invasive transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion. Indian J Orthop 50:464–472. https://doi.org/10.4103/0019-5413.189607

    Article  PubMed  PubMed Central  Google Scholar 

  10. Phan K, Rao PJ, Scherman DB, Dandie G, Mobbs RJ (2015) Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity. J Clin Neurosci 22:1714–1721. https://doi.org/10.1016/j.jocn.2015.03.050

    Article  PubMed  Google Scholar 

  11. Dangelmajer S, Zadnik PL, Rodriguez ST, Gokaslan ZL, Sciubba DM (2014) Minimally invasive spine surgery for adult degenerative lumbar scoliosis. Neurosurg Focus 36:E7. https://doi.org/10.3171/2014.3.Focus144

    Article  PubMed  Google Scholar 

  12. LA Moher D, Tetzlaff J, Altman DG (2009) The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6. https://doi.org/10.1371/journal.pmed.1000097

  13. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605. https://doi.org/10.1007/s10654-010-9491-z

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sun ZJ, Li WJ, Zhao Y, Qiu GX (2013) Comparing minimally invasive and open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: a meta-analysis. Chin Med J 126:3962–3971

    PubMed  Google Scholar 

  15. Parker SL, Adogwa O, Witham TF, Aaronson OS, Cheng J, McGirt MJ (2011) Post-operative infection after minimally invasive versus open transforaminal lumbar interbody fusion (TLIF): literature review and cost analysis. Minim Invasive Neurosurg 54:33–37. https://doi.org/10.1055/s-0030-1269904

    CAS  Article  PubMed  Google Scholar 

  16. Mummaneni PV, Park P, Shaffrey CI, Wang MY, Uribe JS, Fessler RG, Chou D, Kanter AS, Okonkwo DO, Mundis GM, Eastlack RK, Nunley PD, Anand N, Virk MS, Lenke LG, Than KD, Robinson LC, Fu KM (2019) The MISDEF2 algorithm: an updated algorithm for patient selection in minimally invasive deformity surgery. J Neurosurg Spine 32:1–8. https://doi.org/10.3171/2019.7.Spine181104

    Article  Google Scholar 

  17. Mariscalco MWMY, Takayuki MD, Steinmetz MP, Krishnaney AA, Lieberman IH, Mroz TE (2011) Radiation exposure to the surgeon during open lumbar microdiscectomy and minimally invasive microdiscectomy: a prospective, controlled trial. Spine 36(3):255–260

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge Joanne Doucette for her help with search terms.

Author information

Author notes

  1. Rania A. Mekary and Hasan Zaidi are co-senior authors.

Affiliations

  1. Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    Asad M. Lak, Nayan Lamba, Linda Aglio, Christian D. Cerecedo-Lopez, Ian Tafel, Timothy R. Smith, Rania A. Mekary & Hasan Zaidi

  2. Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA

    Farrah Pompilus, Ismaeel Yunusa, Andrella King, Ihtisham Sultan, James Amamoo, Nawaf M. Al-Otaibi, Mohammed Alasmari, Iman Zaghloul & Rania A. Mekary

Authors
  1. Asad M. Lak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nayan Lamba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Farrah Pompilus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ismaeel Yunusa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrella King
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ihtisham Sultan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. James Amamoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nawaf M. Al-Otaibi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mohammed Alasmari
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Iman Zaghloul
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Linda Aglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Christian D. Cerecedo-Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ian Tafel
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Timothy R. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Rania A. Mekary
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Hasan Zaidi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rania A. Mekary.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Asad M. Lak, Nayan Lamba, and Farrah Pompilus are co-first authors.

Appendix

Appendix

Table 3 Search terms
Full size table
Table 4 Comprehensive list of “complications” reported in each study
Full size table

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lak, A.M., Lamba, N., Pompilus, F. et al. Minimally invasive versus open surgery for the correction of adult degenerative scoliosis: a systematic review. Neurosurg Rev 44, 659–668 (2021). https://doi.org/10.1007/s10143-020-01280-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-020-01280-9

Keywords

  • Minimally invasive surgery
  • Open surgery
  • Scoliosis
  • Spinal deformity