P0838 - Minimally Invasive Surgery in Neuromuscular Scoliosis: A Superior Approach for Severely Impaired Patients

Minimally invasive surgery (MIS) approach has been shown to decrease blood loss, pain, transfusion rate and hospital stays in adolescent idiopathic scoliosis (AIS) patients. This approach has never been reported on neuromuscular patients, who have multiple co-morbidities and complications and can benefit greatly from this technique. This study seeks to compare the peri-operative outcomes of MIS approach to standard PSF approach in neuromuscular patients.
A retrospective chart and x-ray review of neuromuscular scoliosis patients operated on from 2005-2016 by a single surgeon. PSF was performed from 2005-2016. MIS approach was adopted in 2014. Perioperative outcomes such as length of operation, transfusions, neuro-monitoring signal changes, estimated blood loss (EBL), and length of stay were recorded. Pre- and postop XRs were reviewed for Cobb angle, kyphosis, levels fused and pelvic obliquity. Median and interquartile ranges were calculated for non-normative distributions and Fisher’s exact test and Wilcoxon Rank Sums tests were used.
158 (Control:126, MIS:32) neuromuscular scoliosis patients underwent surgery between 2005-2017.Patients were of similar age (14.4 vs 13.8, p = 0.384), preop Cobb angle (66 vs 65.9°, p = 0.971), and preop pelvic obliquity (8.5 vs 8.2, p = 0.614). PSF patients had significantly longer surgeries (387 vs 347min, p = 0.017). EBL was significantly higher in PSF (800 vs 500, p <0.0001). Postop Cobb (22 vs 26.4, p = 0.376), and postop pelvic obliquity (5 vs 3, p = 0.175) were similar. MIS had more levels fused (14 vs 15, p=0.054). Complication rates were smaller in MIS, but not significant (39% vs 30%, p=0.432). MIS has significantly shorter hospital stays (10 vs 7days, p=0.001).
Minimally invasive approach provides comparable results for postop Cobb, pelvic obliquity, as well as the greatest benefits to patients in terms of decreased complications, blood loss, surgery length, and hospital stay. MIS should be strongly considered in this group of complex patients.