| Background and objectives:Due to the aging of the population,the prevalence of scoliosis in adults is on the rise.Most patients with degenerative scoliosis are older than 50 years old.The main symptoms are low back pain,lower extremity radiation pain and intermittent claudication.The choice of surgical treatment for patients with degenerative scoliosis has been controversial.Traditional open surgery can significantly improve the clinical symptoms and quality of life of patients,but its surgical trauma and high incidence of complications have led to many minimally invasive surgery in recent years.However,it is unclear about the deformity correction ability of minimally invasive surgery,the incidence of surgery-related complications,and the degree of improvement in postoperative clinical symptoms and quality of life.This study sought to investigate the safety and efficacy of minimally invasive surgery for degenerative scoliosis through systematic reviews and meta-analysis.Method: Search for the Pubmed,Embase,Cochrane,CNKI databases from creating database initially to December 2018,Pubmed,Embase,Cochrane with "degenerative scoliosis","degenerative lumbar scoliosis","de novo scoliosis" as keywords and through the literature database filter Restrict search by exclusion criteria as much as possible.CNKI with "degenerative scoliosis or degenerative lumbar scoliosis or with degenerative scoliosis or with degenerative lumbar scoliosis or with degenerative scoliosis or with degenerative lumbar scoliosis or with degenerative scoliosis or with degenerative lumbar scoliosis" as the Me SH of the journal search,the retrieved literature through the reading of the topic and abstracts to screen preliminarily the literature which study minimally invasive surgery to treat patients with degenerative scoliosis,and Manually search for relevant journals and read the full-text citations mentioned in the study.Finally data were extracted from the literatures that met the inclusion criteria.The patient's age,Cobb angle,lumbar lordosis angle(LL),sagittal vertebrae axis(SVA),ODI,VAS outcome index,complications and fusion rate were extracted for descriptive analysis and utilization of R version 3.5.2 performs meta-analysis.Results:A total of 1947 articles were retrieved from various databases,and a total of 24 articles(872 patients)were included in the study.Despite the significant heterogeneity in the study,the meta-analysis of the random effects model showed that the postoperative Cobb angle and the sagittal vertical axis SVA were reduced by 15.189°(95% CI [10.622°;19.767°]),3.589cm(95% CI [2.076cm;5.103cm]),the postoperative lumbar lordosis angle LL increased by 13.260 °(95% CI [7.186 °;19.333 °]),which was significantly improved compared with preoperative.The Meta-regression model showed that the greater preoperative Cobb angle,the greater degree of postoperative correction(p < 0.0001).Two studies of simple decompression surgery reported no significant differences in preoperative and postoperative cobb angles.In terms of quality of life scores: postoperative VAS,ODI scores were significantly improved compared with preoperative,postoperative ODI decreased by 33.127%,(95% CI [25.496%;40.757%]).Metaregression models showed that the greater preoperative ODI,the greater improvement in postoperative ODI(p <0.0344).Complications: The incidence of sensorimotor abnormalities in the 17 studies was 16.6%(95% CI: 10.9%-24.4%,I2=71%).Among the 15 studies,subgroup analysis was performed according to different approaches.The incidence of sensorimotor abnormalities was 20.9%(95% CI: 12.4%-33.1%,I2=76%)for the lateral approach,and the anterior approach was 14.9%.95% CI: 7.3%-28.1%),posterior approach was 7.0%(95% CI: 2.8%-16.5%,I2 = 22%).Meta-regression analysis showed that the surgical approach was related to the heterogeneity between studies(P=0.0358).The incidences of pseudoarticular joints,wound infection,cage sinking,adjacent segmental disease,and cerebrospinal fluid leakage were 1.4%,3%,5.4%,4.9%,and 3.1%,respectively.The fusion rate of the 11 studies combined was 93%(95% CI: 85.9%-96.7%).Ten studies reported an average of 30.2-386 minutes of surgery,and 13 studies reported an average of 54-771 ml of bleeding.Conclusion:Current research shows that minimally invasive surgery for degenerative scoliosis can effectively correct deformity and improve quality of life inordinately.From the meta-analysis of the complication rate and fusion rate,the incidence of complications of minimally invasive surgery for degenerative scoliosis is low,and the overall fusion rate is high.The existing controlled studies on minimally invasive surgery and open surgery for degenerative scoliosis are still lacking,and the studies included in this study are heterogeneous,so there is no strong evidence that the effectiveness and safety of minimally invasive surgery for degenerative scoliosis is superior to open surgery. |
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