{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:23:56Z","timestamp":1794324236933,"version":"4.9.0"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2013,1]]},"abstract":"\n Object<\/jats:title>\n The treatment of adult spinal deformity (ASD) remains a challenge for the spine surgeon. While minimally invasive surgery (MIS) has many favorable attributes that would be of great benefit for the ASD population, improvements in lordosis and sagittal balance have remained elusive in cases involving the MIS approach. This report describes the evolution of an MIS method for treating ASD with attention to sagittal correction.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Over an 18-month period 25 patients with thoracolumbar scoliosis were treated surgically. The mean patient age was 72 years, and 68% of the population was female. Patients were treated with multilevel facet osteotomies and interbody fusion in which expandable cages (mean 3.2 levels) were placed and percutaneous screw fixation (mean 5.3 levels) was performed. Seven patients underwent supplemental percutaneous iliac fixation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n All patients underwent MIS without conversion to a traditional open procedure. The mean operative time was 273 mins and the mean blood loss was 416 ml. There were no intraoperative complications. The Cobb angle over the scoliotic deformity improved from a mean of 29.2\u00b0 to that of 9.0\u00b0 (p < 0.001). Lumbar lordosis between L-1 and S-1 improved from a mean of 27.8\u00b0 to one of 42.6\u00b0 (p < 0.001). Sagittal vertical axis improved from 7.4 cm to 4.3 cm (p = 0.001). Numeric pain scale scores improved as well, an average of 3.3 and 4.2 for the leg and back, respectively. A mean improvement of 20.8 points on the Oswestry Disability Index was seen at 12 months. Complications included: two cases requiring hardware repositioning, one case of screw pullout, one asymptomatic pedicle screw breach, prolonged hospitalization from constipation, and one acute coronary syndrome developing 3 days after surgery without myocardial damage.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n An expanding body of evidence suggests that sagittal balance remains a keystone for good outcomes after ASD surgery. Minimally invasive surgery that involves a combination of osteotomies, interbody height restoration, and advanced fixation techniques may achieve this goal in patients with less severe deformities. While feasibility will have to be proven with larger series and improved surgical methods, the present technique holds promise as a means of reducing the significant morbidity associated with surgery in the ASD population.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2012.9.spine111081","type":"journal-article","created":{"date-parts":[[2012,10,26]],"date-time":"2012-10-26T10:05:24Z","timestamp":1351245924000},"page":"4-12","source":"Crossref","is-referenced-by-count":56,"title":["Improvement of sagittal balance and lumbar lordosis following less invasive adult spinal deformity surgery with expandable cages and percutaneous instrumentation"],"prefix":"10.3171","volume":"18","author":[{"given":"Michael Y.","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine111081","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"92","DOI":"10.3171\/2011.3.SPINE10425","article-title":"Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study. Clinical article","volume":"15","author":"Acosta","year":"2011"},{"key":"b2-spine111081","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1097\/BSD.0b013e318167b06b","article-title":"Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis: a technique and feasibility study","volume":"21","author":"Anand","year":"2008"},{"issue":"3","key":"b3-spine111081","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E6","DOI":"10.3171\/2010.1.FOCUS09272","article-title":"Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis","volume":"28","author":"Anand","year":"2010"},{"key":"b4-spine111081","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2186","DOI":"10.1097\/BRS.0b013e3181b05146","article-title":"Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients","volume":"34","author":"Bess","year":"2009"},{"issue":"3","key":"b5-spine111081","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E8","DOI":"10.3171\/2010.1.FOCUS09282","article-title":"Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis","volume":"28","author":"Dakwar","year":"2010"},{"issue":"4","key":"b6-spine111081","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E3","DOI":"10.3171\/2011.7.FOCUS11145","article-title":"Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions","volume":"31","author":"Drazin","year":"2011"},{"key":"b7-spine111081","series-title":"J Neurosurg Spine","first-page":"663","article-title":"Editorial. Spinal deformity","volume":"13","author":"Fehlings","year":"2010"},{"issue":"3","key":"b8-spine111081","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E10","DOI":"10.3171\/2009.12.FOCUS09281","article-title":"Correction of lumbar coronal plane deformity using unilateral cage placement","volume":"28","author":"Heary","year":"2010"},{"issue":"26 Suppl","key":"b9-spine111081","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"S322","DOI":"10.1097\/BRS.0b013e3182022e04","article-title":"A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications","volume":"35","author":"Isaacs","year":"2010"},{"key":"b10-spine111081","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1097\/BSD.0b013e3181ffefd2","article-title":"Extreme lateral interbody fusion approach for isolated thoracic and thoracolumbar spine diseases: initial clinical experience and early outcomes","volume":"24","author":"Karikari","year":"2011"},{"key":"b11-spine111081","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2189","DOI":"10.1097\/BRS.0b013e31814b8371","article-title":"Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study","volume":"32","author":"Kim","year":"2007"},{"issue":"1 Suppl","key":"b12-spine111081","series-title":"Neurosurgery","first-page":"ONS-E178","article-title":"Salvage technique of posterior iliac bolt placement in long-segment spinal constructs with a previous posterior iliac crest harvest: technical note","volume":"58","author":"Lippman","year":"2006"},{"issue":"3 Suppl","key":"b13-spine111081","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"S171","DOI":"10.1227\/01.NEU.0000325680.32776.82","article-title":"Pedicle subtraction osteotomy","volume":"63","author":"Mummaneni","year":"2008"},{"key":"b14-spine111081","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1224","DOI":"10.1097\/BRS.0b013e3181714a66","article-title":"Short-term mortality and its association with independent risk factors in adult spinal deformity surgery","volume":"33","author":"Pateder","year":"2008"},{"key":"b15-spine111081","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1227\/01.NEU.0000377851.75513.FE","article-title":"Less invasive surgical correction of adult degenerative scoliosis, part I: technique and radiographic results","volume":"67","author":"Scheufler","year":"2010"},{"issue":"Suppl","key":"b16-spine111081","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/01.bsd.0000132291.50455.d0","article-title":"Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results","volume":"18","author":"Schwender","year":"2005"},{"key":"b17-spine111081","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1227\/01.NEU.0000347005.35282.6C","article-title":"Improvement of back pain with operative and nonoperative treatment in adults with scoliosis","volume":"65","author":"Smith","year":"2009"},{"key":"b18-spine111081","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1097\/BRS.0b013e3181e21783","article-title":"Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age","volume":"36","author":"Smith","year":"2011"},{"issue":"2","key":"b19-spine111081","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E17","DOI":"10.3171\/FOC\/2008\/25\/8\/E17","article-title":"Percutaneous iliac screw placement: description of a new minimally invasive technique","volume":"25","author":"Wang","year":"2008"},{"issue":"3","key":"b20-spine111081","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E9","DOI":"10.3171\/2010.1.FOCUS09286","article-title":"Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes","volume":"28","author":"Wang","year":"2010"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/18\/1\/article-p4.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/18\/1\/article-p4.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/18\/1\/article-p4.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T20:24:13Z","timestamp":1681590253000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/18\/1\/article-p4.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2013,1]]},"references-count":20,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2012.9.spine111081","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2013,1]]}}}