Role of Minimally Invasive Spine Surgery in Adults with Degenerative Lumbar Scoliosis: A Narrative Review

Background and Aim: Degenerative lumbar scoliosis is a spinal deformity resulting from advanced disc degeneration and facet arthropathy. Given the inconclusive available literature and lack of high-quality data supporting the role of minimally invasive surgical management of degenerative lumbar scoliosis, this review intends to highlight and compare the various viable minimally invasive surgical methods for adult degenerative deformity correction. Methods and Materials/Patients: Online databases search including Medline, PubMed and Ovid was preformed using the keywords: adult, degenerative, lumbar scoliosis, etiology, clinical issues, diagnostic imaging, spinopelvic alignment, non-operative and surgical treatment options, minimally invasive, interbody fusion, and percutaneous pedicle screw fixation. Eighty-three studies, published after 2000, on degenerative lumbar scoliosis epidemiology, classification and management were identified and reviewed. Results: Minimally invasive surgical techniques available for interbody fusion include posterior lumbar interbody fusion, transformational lumbar interbody fusion, oblique lumbar interbody fusion, anterior lumbar interbody fusion, and extreme lateral interbody fusion. Each surgical option warrants technical considerations, indication, complications awareness, and functional and radiological outcomes assessment. Sound patients’ selection is key for improved outcomes, and therefore the following factors should be well examined prior to surgical intervention: the patient’s medical condition and underlying morbidities, the extent of the involved disc spaces, imaging characteristics, and surgeon skills. Conclusion: The superiority of one surgical technique over the others, was not proven due to lack of strong and supportive data. However, a comprehensive review of indications, benefits, and disadvantages of the minimally invasive surgical procedures is presented. There is an interest in minimally invasive surgery of the spine owing to lower complication rates and morbidity, with limited soft tissue disturbance, decreased blood loss, improved cosmesis, shorter hospital stay, earlier return to work, and therefore decreased general health care costs.