Single Long-Incision Minimally Invasive Surgery

Study Design. Retrospective cohort study. Objective. The objective of this study is to determine differences in outcomes in patients with adolescent idiopathic scoliosis undergoing spinal deformity correction surgery using a posterior spinal fusion (PSF) approach versus single and triple-incision minimally invasive surgery (MIS). Summary of Background Data. MIS increased in popularity as surgeons' focus moved towards soft tissue preservation, but it carries technical demands and increased surgical time compared with PSF. Patients and Methods. Surgeries performed from 2016 to 2020 were included. Cohorts were formed based on surgical approach: PSF versus single long-incision MIS (SLIM) versus traditional MIS [3-incision MIS (3MIS)]. There were a total of 7 subanalyses. Demographic, radiographic, and perioperative data were collected for the 3 groups. Kruskal-Wallis and χ²tests were used for continuous and categorical variables, respectively. Results. Five hundred thirty-two patients met our inclusion criteria, 294 PSF, 179 3MIS, and 59 SLIM. Estimated blood loss (mL) (P < 0.00001) and length of stay (LOS) (P < 0.00001) was significantly higher in PSF than in SLIM and 3MIS. Surgical time was significantly higher in 3MIS than in PSF and SLIM (P = 0.0012). Patients who underwent PSF had significantly lower postoperative T5 to T12 kyphosis (P < 0.00001) and percentage kyphosis change (P < 0.00001). Morphine equivalence was significantly higher in the PSF group during total hospital stay (P = 0.0042). Patients who underwent SLIM and 3MIS were more likely to return to noncontact (P = 0.0096) and contact sports (P = 0.0095) within 6 months and reported lower pain scores (P < 0.001) at 6 months postoperation. Conclusion. SLIM has a similar operative time to PSF and is technically similar to PSF while maintaining the surgical and postoperative outcome advantages of 3MIS.