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

    Final Number:

    Khoi Duc Than MD; Stacie Nguyen BS MPH; Paul Park MD; Dean Chou MD; Frank La Marca MD; Juan S. Uribe MD; Todd Douglas Vogel MD; Pierce D. Nunley MD; Robert Eastlack MD; Neel Anand MD; Adam S. Kanter MD; Praveen V. Mummaneni MD; Gregory M. Mundis MD; International Spine Study Group

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: 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).

    Methods: 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.

    Results: 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 (Table 1). 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).

    Conclusions: 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.

    Patient Care: To better understand the complications associated with MIS and HYB surgery, to assist with patient selection.

    Learning Objectives: 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.


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