Adult Degenerative Scoliosis Treated With XLIF Clinical and Radiographical Results of a Prospective Multicenter Study With 24-Month Follow-up
1Midwest Orthopaedics at Rush University Medical Center, Chicago, IL 2Division of Neurosurgery, Duke University Medical Center, Durham, NC 3Spine Midwest, Inc., Jefferson City, MO 4Georgia Spine and Neurosurgery Center, Decatur, GA 5INSPIRE Research Foundation, Decatur, GA 6Northwest Orthopaedic Specialists, Spokane, WA 7University of California San Francisco, San Francisco, CA 8Southern Oregon Orthopedcis, Medford, OR 9South Florida Spine Institute, Miami Beach, FL.Spine (Impact Factor: 2.3). 07/2013; 38(21). DOI: 10.1097/BRS.0b013e3182a43f0b
Study Design: Prospective, multi-center, single-arm study.Objective: The objective of this study was to evaluate the clinical and radiographic results of patients undergoing a minimally disruptive lateral transpsoas retroperitoneal surgical approach (XLIF) for the treatment of degenerative scoliosis (DS).Summary of Background Data: Surgery for the treatment of DS has been reported to have acceptable results but is traditionally associated with high morbidity and complication rates. A minimally disruptive lateral transpsoas retroperitoneal surgical approach (XLIF) has become popular for the treatment of DS. This is the first prospective, multi-center study to quantify outcomes following XLIF in this patient population.Methods: 107 patients with DS who underwent the XLIF procedure with or without supplemental posterior fixation at one or more intervertebral levels were enrolled in this study. Clinical and radiographic results were evaluated up to 24 months after surgery.Results: Mean patient age was 68 years; 73% of patients were female. A mean of 3.0 (range 1-6) levels were treated with XLIF per patient. Overall complication rate was low compared with traditional surgical treatment for DS. Significant improvement was seen in all clinical outcome measures at 24 months: ODI, VAS back, VAS leg, SF-36 MCS and PCS (p<0.001). Eighty-five percent of patients were satisfied with their outcome and would undergo the procedure again. In hypolordotic patients, lumbar lordosis was corrected from a mean of 27.7° to 33.6° at 24 months (p<0.001). Overall Cobb angle was corrected from 20.9° to 15.2° with the greatest correction observed in patients supplemented with bilateral pedicle screws.Conclusion: The current study demonstrates the utility of the XLIF procedure in the treatment of DS. XLIF is associated with good clinical and radiographic outcomes with a substantially lower complication rate than has been reported with traditional surgeries.
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ABSTRACT: The purpose of this study was to examine radiographic and clinical outcomes in the treatment of adult degenerative scoliosis using a minimally invasive (MI) lateral approach for anterior lumbar interbody fusion (IBF). A prospective study of 24 consecutive degenerative scoliosis patients treated with MI, 90° lateral, transpsoas approach for anterior IBF was conducted. Twenty-one patients (88 %) were available for at least 12 months follow-up (mean 24 months). Mean operating time, estimated blood loss, and length of stay was 218 min, 68 mL, and 2.2 days, respectively. Complications occurred in one (5 %) case, a postoperative foot drop. At the last follow-up, disability improved by 50 % from 48.4 to 24.4. Back pain improved by 59 % from 7.0 to 2.9. Leg pain improved by 41 % from 5.6 to 3.3. In patients with a baseline score greater than 2.0, leg pain decreased by 42 % from 6.6 to 3.8. SF-36 physical component score improved by 41 % from 28.0 to 39.6, while mental component score increased by 18 % from 42.2 to 49.8. All changes were statistically significant, p < 0.05. Cobb angle was corrected from 27.7° to 16.6° and lumbar lordosis increased 39 % from -31.8° to -44.0°. Disc height increased from 5.7 to 11.6 mm, segmental lordosis increased by 48 % from 11.6° to 17.2°, and foraminal height increased from 16.4 to 21.7 mm. At the last follow-up, 100 % of patients were satisfied with their outcome, and 86 % would undergo the same procedure again. No revisions occurred. MI lateral IBF in the treatment of degenerative scoliosis results in lower complication rates and clinical and radiographic outcomes equivalent to reports in the literature of conventional approaches.
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ABSTRACT: The outcomes and complications of posterior-only lumbar instrumented long fusions exceeding three segments with selective segmental transforaminal lumbar interbody fusion for the treatment of degenerative lumbar scoliosis, kyphosis, or both combined with spondylolisthesis were analyzed to investigate risk factors associated with surgical instrumentation failure. Fifteen consecutive patients with degenerative lumbar scoliosis, kyphosis, or both combined with spondylolisthesis were studied retrospectively. There were 5 male and 10 female patients, with a mean age of 71.8 years. All the patients were followed for a mean duration of 19.4 months postoperatively. Radiographic evaluation included coronal Cobb angle, lumbar lordosis (LL) angle, pelvic incidence (PI), and pelvic tilt (PT). The clinical outcomes were assessed by means of Japanese Orthopedic Association (JOA) score. Patients were divided into two groups: group 1-7 patients with surgical complications; group 2-8 patients without complications. The preoperative and postoperative coronal Cobb's angle were not significantly different between groups 1 and 2. The LL highly correlated with developing surgical complications. There were statistically significant differences in preoperative and postoperative LL and the mean difference between PI and the LL (PI-LL) between groups 1 and 2. Linear correlation and regression analysis showed that there was no correlation between JOA score and the coronal Cobb angle in degenerative scoliosis patients. However, we found a positive correlation between JOA and LL. Our series of long lumbar fusions had a high complication and instrumentation failure. Creating adequate LL angle in harmony with PI was a key to prevent surgical complications and attain neurological improvement.
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ABSTRACT: Purpose The recent proliferation of minimally invasive lateral lumbar interbody fusion (LLIF) techniques has drawn attention to potential for these techniques to control or correct sagittal misalignment in adult spinal deformity. We systemically reviewed published studies related to LLIF use in adult spinal deformity treatment with emphasis on radiographic assessment of sagittal balance. Methods A literature review was conducted to examine studies focusing on sagittal balance restoration in adult degenerative scoliosis with the LLIF approach. Results Fourteen publications, 12 retrospective and 2 prospective, reported data regarding lumbar lordosis correction (1,266 levels in 476 patients) but only two measured global sagittal alignment. Conclusion LLIF appears to be especially effective when the lumbar lordosis and sagittal balance correction goals are less than 10 degrees and 5 cm, respectively. However, the review demonstrated a lack of consistent reporting on sagittal balance restoration with the MIS LLIF techniques.
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