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KMID : 1040920230080000085
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Journal of Minimally Invasive Spine Surgery and Technique
2023 Volume.8 No. 0 p.85 ~ p.91
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Interstage Imaging in Staged Minimally Invasive Spinal Deformity Surgery
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John Paul G. Kolcun
Ryan M. Kelly
Daniel I. Wolfson
Dustin H. Kim
Ricardo B. V. Fontes
Richard G. Fessler
John E. O′Toole
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Abstract
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Objective : Spinal surgeons have developed novel minimally invasive (MIS) protocols to correct adult degenerative spinal deformities in well-selected patients. Many surgeons perform these cases in stages: first by an anterior/lateral approach for interbody device placement, and second by a posterior approach for fixation. Imaging is typically obtained in between these 2 stages to reassess the surgical anatomy. We evaluated the utility of interstage imaging by comparing alignment parameters between baseline, interstage, and final postoperative radiographs.
Methods : We reviewed MIS deformity cases performed at our institution by 3 expert surgeons, which were staged and had complete preoperative, interstage, and postoperative radiographs. Standard alignment parameters at all timepoints were compared.
Results : Thirty-three patients met the criteria for inclusion. There were significant differences between baseline and interstage values for lumbar lordosis (LL, p=0.004), pelvic tilt (PT, p=0.002), and pelvic incidence-lumbar lordosis mismatch (PI-LL, p=0.002). No significant differences existed between interstage and postoperative measurements for these sagittal parameters. Significant differences were found between interstage and postoperative values for the major Cobb angle (p=0.012) and the lumbar Cobb angle (p=0.016).
Conclusions : In staged cases, our surgeons typically obtain interstage imaging, primarily standing scoliosis films. These studies inform the final levels of instrumentation and the need for additional posterior osteotomies/decompression during stage II. Based on interstage imaging findings, most sagittal correction occurs after stage I, while coronal correction occurs after stage II.
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KEYWORD
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Spine, Minimally-invasive surgical procedures, Spinal fusion
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