Frank M. Phillips, MD, Professor of Orthopedic Surgery at Rush University Medical Center and Co-Director of the Midwest Orthopaedics at Rush Minimally Invasive Spine Institute in Chicago, recently published results of a study examining the eXtreme Lateral Interbody Fusion (XLIF) procedure for patients with degenerative scoliosis. This is the largest published study of patients with degenerative scoliosis treated with minimally invasive fusion surgery.
Dr. Phillips and his colleagues followed 107 degenerative scoliosis patients who underwent XLIF procedures for 24 months. These patients had good clinical results with a lower complication rate than has been reported for patients who had traditional open surgery.
"Over the past decade, there has been a push toward minimally invasive spinal surgery," says Dr. Phillips. "As surgeons are now exposed to MIS techniques in fellowship and residency training and have become more comfortable with these techniques, we are seeing MIS approaches developing to address complex spinal problems, including scoliosis and deformity correction."
Less invasive procedures potentially have several advantages for patients, including:
• Shorter operative time
• Shorter length of stay at the hospital
• Fewer complications
• Fewer reoperations
• Less blood loss
• Lower costs
"The interesting finding of this study is not only the lower complication profile with XLIF compared to that reported in prior studies on open scoliosis surgery, but also the clinical outcomes seem to improve rapidly within two to three months. This is in contrast to outcomes reported after open scoliosis surgery where patients may not reach that point till six months or longer after the surgery," says Dr. Phillips. "Patients are clearly recovering more quickly after surgery."
The less invasive procedures for scoliosis surgery are very promising, but there is a learning curve to incorporating those procedures into practice. "It's not something that 'open' surgeons can just pick up and instinctively do," says Dr. Phillips. "You need training and minimally invasive skills and aptitude."
Clearly less invasive surgery and lateral interbody fusion is gaining wider acceptance. In 2005, Dr. Phillips presented a paper first introducing lateral surgery (XLIF) for scoliosis and many of his colleagues were skeptical about whether it would work. Over the past nine years, however, that attitude has changed.
"Now that lateral approaches have become more widely adopted, surgeons feel like they need to incorporate these into their armamentarium or be left behind," says Dr. Phillips. ".Surgeons who regarded themselves as traditional open deformity surgeons used to look at minimally invasive techniques as not being able to accomplish the goals of surgery, but now with this study we have shown the role for XLIF for degenerative scoliosis surgery."
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