New research co-authored by Dean Chou, MD, chief of the Division of Spine Surgery at Och Spine at NewYork-Presbyterian and Columbia, shows that performing circumferential minimally invasive spinal deformity correction surgery in stages is just as effective as doing it as a single, same-day procedure.
The findings add to a growing body of research showing that minimally invasive surgery (MIS) is a safe and effective option for patients in a variety of complex surgical cases, including adult spinal deformity correction and scoliosis surgery. With greater consensus that MIS is appropriate for increasingly complex cases, surgeons can now examine which patients are best suited for staged surgery. However, the impact of staging MIS scoliosis surgery, in particular, has not been well studied.
Below, Dr. Chou shares results from the study that compared the long-term clinical and radiographic outcomes for patients who underwent either staged or same-day circumferential MIS for adult spinal deformity and how the findings will impact patient care in the future.
Carefully selected patients had similar outcomes whether they underwent staged or same-day circumferential minimally invasive deformity correction.
Staged Vs. Same-Day Surgery
It’s common for surgeons performing MIS scoliosis surgery to stage the procedure over two different days to account for the complexity involved, time under anesthesia, and the potential for surgeon fatigue during an operation that can last all day. Patients, on the other hand, often prefer to have their surgery completed in a single day. Our study, which included multiple sites in the International Spine Study Group (ISSG), aimed to evaluate the long-term outcomes for each approach among patients who fall into class III and class IV on the MIS deformity (MISDEF2) algorithm due to severe sagittal and coronal deformities.
Key Findings
We retrospectively reviewed two-years of clinical and radiographic outcomes of patients who underwent MIS scoliosis surgery over two stages or in one stage. Overall, we found no significant difference in pre-operative and postoperative clinical parameters and no difference in postoperative radiographic outcomes between patients who had staged surgery and those who had same-day procedures.
Other findings of note included that:
- At baseline, patients who underwent staged surgery had significantly greater frailty scores.
- Patients in the staged group had more extensive surgeries, greater blood loss, more total levels of interbody and posterior fusion, and longer operative times and hospital lengths of stay.
- Patients who underwent staged surgery vs. same-day surgery required more blood transfusions (51.9% vs. 12.1% respectively), probably because more extensive surgeries were staged.
Overall, it is reasonable to consider the extent of the surgery for either staged or same-day surgery. For instance, a patient whose operating time is likely to exceed seven hours, will undergo more than three interbody fusion levels, or has more than five posterior fusion levels is likely to be a good candidate for a staged approach. In contrast, patients in better health with a projected shorter operating time may be better candidates for a same-day procedure. In the end, this study provides validation to surgeons to stage patients when it is best for the patient.
Future Implications
As we look to the future, our ultimate goal is to perform more spine procedures using a MIS approach as a complement to open surgery, which is currently done extremely well at Och Spine. NewYork-Presbyterian is already a leader in bringing minimally invasive techniques to both adult spine deformity and scoliosis surgery, and research like this enables us to better define the group of patients who can benefit from a minimally invasive approach.
