J Korean Neurosurg Soc.  2018 Nov;61(6):716-722. 10.3340/jkns.2017.0275.

Contribution of Lateral Interbody Fusion in Staged Correction of Adult Degenerative Scoliosis

• Choi SW
• Ames C
• Berven S
• Chou D
• Tay B
• Deviren V

• KMID: 2428113
• DOI: http://doi.org/10.3340/jkns.2017.0275

Abstract

OBJECTIVE
Lateral interbody fusion (LIF) is attractive as a less invasive technique to address anterior spinal pathology in the treatment of adult spinal deformity. Its own uses and benefits in treatment of adult degenerative scoliosis are undefined. To investigate the radiographic and clinical outcomes of LIF, and staged LIF and posterior spinal fusion (PSF) for the treatment of adult degenerative scoliosis patients, we analyzed radiographic and clinical outcomes of adult degenerative scoliosis patients who underwent LIF and posterior spinal fusion.
METHODS
Forty consecutive adult degenerative scoliosis patients who underwent LIF followed by staged PSF at a single institution were retrospectively reviewed. Long-standing 36" anterior-posterior and lateral radiographs were taken preoperatively, at inter-stage, 3 months, 1 year, and 2 years after surgery were reviewed. Outcomes were assessed through the visual analogue scale (VAS), 36-Item Short Form Health Survey (SF-36), and Oswestry Disability Index (ODI).
RESULTS
Forty patients with a mean age of 66.3 (range, 49-79) met inclusion criteria. A mean of 3.8 levels (range, 2-5) were fused using LIF, while a mean of 9.0 levels (range, 3-16) were fused during the posterior approach. The mean time between stages was 1.4 days (range, 1-6). The mean follow-up was 19.6 months. Lumbar lordosis was significantly restored from 36.4º preoperatively up to 48.9º (71.4% of total correction) after LIF and 53.9º after PSF. Lumbar coronal Cobb was prominently improved from 38.6º preoperatively to 24.1º (55.8% of total correction) after LIF, 12.6º after PSF respectively. The mean pelvic incidence-lumbar lordosis mismatch was markedly improved from 22.2º preoperatively to 8.1º (86.5% of total correction) after LIF, 5.9º after PSF. Correction of coronal imbalance and sagittal vertebral axis did not reach significance. The rate of perioperative complication was 37.5%. Five patients underwent revision surgery due to wound infection. No major perioperative medical complications occurred. At last follow-up, there were significant improvements in VAS, SF-36 Physical Component Summary and ODI scores.
CONCLUSION
LIF provides significant corrections in the coronal and sagittal plane in the patients with adult degenerative scoliosis. However, LIF combined with staged PSF provides more excellent radiographic and clinical outcomes, with reduced perioperative risk in the treatment of adult degenerative scoliosis.

Keyword

Spine; Deformity; Fusion; Correction

MeSH Terms

Adult*
Animals
Congenital Abnormalities
Follow-Up Studies
Health Surveys
Humans
Lordosis
Pathology
Retrospective Studies
Scoliosis*
Spinal Fusion
Spine
Wound Infection

Figure

• 

  Fig. 1. In a 60-year-old female, preoperative coronal Cobb angle of 69° and lumbar lordosis of 46° (A) were corrected to 47° and 60° after lateral interbody fusion (B) and 26° and 58° after posterior spinal fusion (C). The angles measured 27° and 54° respectively at 2 years later (D).

Reference

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