Outcomes of Hybrid Approaches Combining Minimally Invasive Surgery and Traditional Open Surgery for Adult Scoliosis: A Systematic Review and Meta-analysis

Introduction: Hybrid surgery, combining both open and minimally invasive techniques, is increasingly used for the management of scoliosis and other adult spinal deformities (ASD). However, there remains limited evidence comparing hybrid surgery with minimally invasive surgery (MIS) in terms of operative and clinical outcomes. This study aimed to perform a meta-analysis to evaluate the outcome of hybrid surgery and compare it with other methods for ASD.

Methods: Based on the PRISMA guidline, a systematic search was conducted across EMBASE, Scopus, Web of Science, and PubMed up until September 15th, 2024. A random-effects meta-analysis was performed to evaluate different variables.

Results: In total, 929 patients took part in the study, with 370 undergoing hybrid surgery. The average age of the participants who received hybrid surgery was 63.20 (95% CI 60.17 – 66.22), and 74% (95% CI 59%-85%) of them were female. The overall operative time for hybrid surgery was 585.79 minutes (95% CI 358.81–812.78), which was significantly longer compared to the MIS method (P < 0.001). The estimated blood loss for hybrid surgery was 1444.99 mL (95% CI 776.12–2113.87), also significantly higher than MIS (P < 0.0001). Radiographic outcomes showed significant improvement in lumbar lordosis (mean difference 12.66, 95% CI 6.16–19.16) and SVA (mean difference -24.9970, 95% CI -2.42 to 24.9970, P = 0.02). For clinical outcomes, hybrid surgery showed a significant reduction in VAS for back pain (mean difference -4.38, 95% CI -4.38 to -2.43, P < 0.0001). Although both groups showed improvement in ODI scores, no significant difference was found between hybrid surgery and MIS, with higher ODI values in the MIS group (mean difference -23.70, 95% CI -16.59 to -23.70, P < 0.0001).

Conclusion : Hybrid surgery is associated with longer operative time and higher blood loss compared to MIS in the treatment of scoliosis and other ASDs. However, it demonstrates significant radiographic and clinical improvements, especially in lumbar lordosis and VAS for back pain, with no significant differences in functional outcomes (ODI) between the two methods.