Our Summary

This research paper investigates the impact of staging (performing surgery over separate operative days) on complication rates in two types of minimally invasive surgeries for adult spinal deformity. The two types of surgeries are hybrid (HYB; combination of minimally invasive and open surgery) and circumferential minimally invasive surgery (cMIS; completely minimally invasive).

The study looked at a database of patients who underwent these procedures and found that more complications occurred with the hybrid surgery, especially during and immediately after the operation. However, in the first 30 days after surgery, more patients who underwent the cMIS procedure had to return to the operating room than those who had the hybrid procedure.

Despite this, patients who underwent the cMIS procedure saw a greater improvement in their disability level. The study concludes that cMIS staged surgeries appear to be safer than hybrid staged surgeries, and just as safe as cMIS surgeries that aren’t staged. It suggests that hybrid surgeries may have better results when performed all at once, while cMIS surgeries can be performed in one or two stages, depending on what the surgeon thinks is best.

FAQs

  1. What types of spinal surgeries were compared in this research study?
  2. What were the findings about complication rates in hybrid and cMIS surgeries?
  3. Does the study suggest that cMIS surgeries can be performed in stages or all at once?

Doctor’s Tip

A doctor might tell a patient considering spinal surgery to discuss with their surgeon the option of staging the surgery, especially if they are considering a hybrid procedure. Staging the surgery may help reduce complications during and immediately after the operation. Additionally, patients should be aware that there may be a slightly higher chance of needing a return to the operating room within the first 30 days after surgery with circumferential minimally invasive surgery, but this procedure may lead to greater improvement in disability level. It is important for patients to have a thorough discussion with their surgeon about the benefits and risks of staging the surgery to determine the best approach for their individual case.

Suitable For

Patients who are typically recommended spinal surgery include those with severe back pain that does not improve with conservative treatment methods such as physical therapy or medication, those with progressive neurological symptoms such as weakness or numbness in the limbs, and those with spinal deformities such as scoliosis or kyphosis. Additionally, patients with spinal fractures, tumors, or infections may also be recommended for spinal surgery. The decision to undergo spinal surgery is typically made after a thorough evaluation by a spine specialist who will consider the patient’s symptoms, medical history, and imaging studies to determine the best course of treatment.

Timeline

Before spinal surgery, a patient typically goes through a series of steps including consultation with a surgeon, pre-operative testing such as blood work and imaging scans, and possibly physical therapy or other treatments to prepare for the surgery. The patient may also need to make lifestyle changes, such as quitting smoking or losing weight, to reduce the risk of complications during surgery.

During the surgery itself, the patient is under anesthesia and the surgeon performs the necessary procedures to address the spinal issue. The length and complexity of the surgery will vary depending on the specific condition being treated.

After spinal surgery, the patient will typically spend some time recovering in the hospital before being discharged. This may involve pain management, physical therapy, and monitoring for any potential complications. The patient will need to follow post-operative instructions provided by their surgeon, which may include restrictions on activities, medications, and follow-up appointments.

Over time, the patient will gradually recover and may experience improvements in their symptoms and overall quality of life. It can take several weeks to months for full recovery from spinal surgery, and ongoing rehabilitation and follow-up care may be necessary to ensure the best possible outcome.

What to Ask Your Doctor

  1. What type of spinal surgery do you recommend for my condition - hybrid or circumferential minimally invasive surgery (cMIS)?
  2. What are the potential complications associated with each type of surgery?
  3. How does staging the surgery (performing it over separate operative days) impact complication rates?
  4. What is the expected recovery time for each type of surgery, both with and without staging?
  5. Are there any specific factors about my condition or health history that may make one type of surgery or staging approach more suitable for me?
  6. What are the long-term outcomes and success rates associated with each type of surgery and staging approach?
  7. How will pain management be handled during and after the surgery, and does staging impact this?
  8. What rehabilitation or physical therapy will be needed after the surgery, and does staging impact this?
  9. How will follow-up care and monitoring be conducted after the surgery, and does staging impact this?
  10. Are there any alternative treatment options to consider besides spinal surgery, and how do they compare in terms of risks and benefits?

Reference

Authors: Than KD, Park P, Tran S, Mundis GM, Fu KM, Uribe JS, Okonkwo DO, Nunley PD, Fessler RG, Eastlack RK, Kanter A, Anand N, LaMarca F, Passias PG, Mummaneni PV; International Spine Study Group. Journal: World Neurosurg. 2019 Jun;126:e1337-e1342. doi: 10.1016/j.wneu.2019.03.090. Epub 2019 Mar 18. PMID: 30898739