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Purpose <p>Adult spinal deformity (ASD) is becoming increasingly prevalent as the general population ages, and this pathology has traditionally been treated with open surgical techniques, which are associated with high complications rates. To reduce surgical aggressiveness, minimally invasive techniques (MIS) are being used with growing frequency. However, concerns persist regarding their ability to correctly re-align the spine on the sagittal plane and to ensure good clinical outcomes. The aim of our study is to evaluate the capacity of MIS techniques to correct ASD sagittal malalignment and assess their clinical outcomes.</p> Materials and methods <p>We systematically reviewed the literature following the PRISMA flowchart. Only articles with a minimum follow-up (FU) of 18 months and &gt; 3.5 fused levels were included. The radiological parameters evaluated were pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L4S1 lordosis (LL L4S1), PI-LL, sagittal vertical axis (SVA), coronal Cobb angle and central sacral vertical line (CSVL). Clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) scores and the main complications were reviewed.</p> Results <p>Six articles were included, comprising a total of 413 patients. The population mean age at surgery was 67.6 years and 71.9% were female. The mean FU was 27.8 months. The mean levels fused were 6.3; all deformities were corrected with MIS anterior, lateral or posterior interbody cages and the posterior instrumentation was positioned percutaneously. The mean PI was 54.6° and remained stable after surgery; all other sagittal and coronal parameters showed statistically significant improvement after surgery (<i>p</i> &lt; 0.05). All clinical outcome scores improved significantly at last FU (<i>p</i> &lt; 0.05). Despite the satisfactory clinical outcomes, the overall rate of major complications was 35.4%, leading to a 19.1% re-intervention rate.</p> Conclusion <p>Despite the satisfactory clinical outcomes, MIS techniques are associated with a high incidence of mechanical complications and revision rate. It can be hypothesized that this may be due to the limited capacity of MIS procedures to respect Roussouly’s phenotypes; nevertheless, the small sample size, the impossibility to stratify the outcomes by MIS technique, and the lack of important patient related factors limits the impact of the current evidence.</p>

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Minimally invasive surgery in adult spinal deformity: sagittal alignment correction potential and clinical outcomes. A systematic review of the literature

  • 期刊论文

  • 发表日期：

    2026年8月3日

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  • Emanuele Quarto,
  • Andrea Zanirato,
  • Samuel Jeffery Marston,
  • Haytham Alhourani,
  • Luca Armani,
  • Eugenia Massarini,
  • Alberto Vandenbulcke,
  • Anais Luyet,
  • Julien Dimitriou,
  • Matteo Formica,
  • Jean Charles Le Huec

摘要

Purpose

Adult spinal deformity (ASD) is becoming increasingly prevalent as the general population ages, and this pathology has traditionally been treated with open surgical techniques, which are associated with high complications rates. To reduce surgical aggressiveness, minimally invasive techniques (MIS) are being used with growing frequency. However, concerns persist regarding their ability to correctly re-align the spine on the sagittal plane and to ensure good clinical outcomes. The aim of our study is to evaluate the capacity of MIS techniques to correct ASD sagittal malalignment and assess their clinical outcomes.

Materials and methods

We systematically reviewed the literature following the PRISMA flowchart. Only articles with a minimum follow-up (FU) of 18 months and > 3.5 fused levels were included. The radiological parameters evaluated were pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), L4S1 lordosis (LL L4S1), PI-LL, sagittal vertical axis (SVA), coronal Cobb angle and central sacral vertical line (CSVL). Clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) scores and the main complications were reviewed.

Results

Six articles were included, comprising a total of 413 patients. The population mean age at surgery was 67.6 years and 71.9% were female. The mean FU was 27.8 months. The mean levels fused were 6.3; all deformities were corrected with MIS anterior, lateral or posterior interbody cages and the posterior instrumentation was positioned percutaneously. The mean PI was 54.6° and remained stable after surgery; all other sagittal and coronal parameters showed statistically significant improvement after surgery (p < 0.05). All clinical outcome scores improved significantly at last FU (p < 0.05). Despite the satisfactory clinical outcomes, the overall rate of major complications was 35.4%, leading to a 19.1% re-intervention rate.

Conclusion

Despite the satisfactory clinical outcomes, MIS techniques are associated with a high incidence of mechanical complications and revision rate. It can be hypothesized that this may be due to the limited capacity of MIS procedures to respect Roussouly’s phenotypes; nevertheless, the small sample size, the impossibility to stratify the outcomes by MIS technique, and the lack of important patient related factors limits the impact of the current evidence.