The MiSLAT Algorithm: Minimally Invasive Evaluation and Treatment for Adult Degenerative Deformity

The goals of adult spinal deformity treatment are to reduce pain, arrest progression of the deformity, restore sagittal and coronal balance, improve neurological function, and improve cosmesis. Traditional open approaches can achieve these goals. However, surgical treatment of adult spinal deformity is associated with substantial surgical risks, especially due to the increased age and associated medical comorbidities of many patients with adult spinal deformity. Open scoliosis surgery is associated with prolonged operative times and significant blood loss. Complication rates of adult deformity surgery are as high as 41.2 % [1]. A recent International Spine Study Group (ISSG) study reviewed a total of 953 adult spinal deformity patients with minimum 2-year follow-up to identify patients with major perioperative complications. Ninety-nine major complications were observed in 72 patients (7.6 %). The most common complications were excessive blood loss (>4 L) and deep wound infection requiring reexploration of the wound and pulmonary embolism [2]. Minimally invasive approaches for adult spinal deformity surgery have been developed to address the high perioperative morbidity of traditional open approaches [3–6].