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Combined anterior lumbar interbody fusion and instrumented posterolateral fusion for degenerative lumbar scoliosis: indication and surgical outcomes.

Hsieh MK, Chen LH, Niu CC, Fu TS, Lai PL, Chen WJ - BMC Surg (2015)

Bottom Line: At the final follow-up, the mean ODI score improved from 28.8 to 6.4, and the mean back/leg VAS, from 8.2/5.5 to 2.1/0.9 in AP group and the mean ODI score improved from 29.1 to 6.2, and the mean back/leg VAS, from 9.0/6.5 to 2.3/0.5 in P group.The mean scoliotic angle changed from 41.3° preoperatively to 9.3°, and the lumbar lordotic angle, from 3.1° preoperatively to 35.7° in AP group and the mean scoliotic angle from 38.5 to 21.4 and the lumbar lordotic angle from 6 to 15.8 in P group.There were significant differences in sagittal (P = 0.009) and coronal (P = 0.02) plane correction between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin Street, Kweishan Shiang, Taoyuan, 333, Taiwan. stock-best@yahoo.com.tw.

ABSTRACT

Background: Traditional approaches to deformity correction of degenerative lumbar scoliosis include anterior-posterior approaches and posterior-only approaches. Most patients are treated with posterior-only approaches because the high complication rate of anterior approach. Our purpose is to compare and assess outcomes of combined anterior lumbar interbody fusion and instrumented posterolateral fusion with posterior alone approach for degenerative lumbar scoliosis with spinal stenosis.

Methods: Between November 2002 and November 2011, a total of 110 patients with degenerative spinal deformity and curves measuring over 30° were included. Of the 110 patients who underwent surgery, 56 underwent the combined anterior and posterior approach and 54 underwent posterior surgery at our institution. The following were the indications of anterior lumbar interbody fusion: (1) rigid or frank lumbar kyphosis, (2) anterior or lateral bridged traction osteophytes, (3) gross coronal and sagittal deformity or imbalance, and (4) severe disc space narrowing that is not identifiable when performing posterior or transforaminal lumbar interbody fusion. The clinical outcomes were evaluated using the Oswestry disability index and the visual analog scale. The status of fusion were assessed according to the radiographic findings.

Results: All patients received clinical and radiographic follow-up for a minimum of 24 months, with an average follow-up of 53 months (range, 26-96 months). At the final follow-up, the mean ODI score improved from 28.8 to 6.4, and the mean back/leg VAS, from 8.2/5.5 to 2.1/0.9 in AP group and the mean ODI score improved from 29.1 to 6.2, and the mean back/leg VAS, from 9.0/6.5 to 2.3/0.5 in P group. The mean scoliotic angle changed from 41.3° preoperatively to 9.3°, and the lumbar lordotic angle, from 3.1° preoperatively to 35.7° in AP group and the mean scoliotic angle from 38.5 to 21.4 and the lumbar lordotic angle from 6 to 15.8 in P group. There were significant differences in sagittal (P = 0.009) and coronal (P = 0.02) plane correction between the two groups.

Conclusions: Our results demonstrate that combined anterior lumbar interbody fusion and instrumented posterolateral fusion for adult degenerative lumbar scoliosis effectively improves sagittal and coronal plane alignment than posterior group and both group were effectively improves clinical scores.

No MeSH data available.


Related in: MedlinePlus

A 64-year-old woman complained low back pain with bilateral sciatica and claudication for several years. Radiographs of anteroposterior view (A) and lateral view (B) showing degenerative lumbar scoliosis from T12 to L5 with lateral bridged traction vertebral osteophytes over L2-3,L3-4 associated with severe disc space narrowing over L1-2 ,L2-3. After anterior lumbar interbody fusion with three SynCages over L1-2, L2-3, and L3-4, the scoliotic angle (T12-L4) was improved from 37° to 17° (C) and the lumbar lordotic curve was improved from 4° to 29° (D). One week later, posterior instrumentation of T12-S1 with posterior interbody fusion of L5-S1 was performed. The scoliotic angle was improved from 17° to 6° (E) and the lumbar lordotic curve was improved from 29° to 36° (F).
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Fig1: A 64-year-old woman complained low back pain with bilateral sciatica and claudication for several years. Radiographs of anteroposterior view (A) and lateral view (B) showing degenerative lumbar scoliosis from T12 to L5 with lateral bridged traction vertebral osteophytes over L2-3,L3-4 associated with severe disc space narrowing over L1-2 ,L2-3. After anterior lumbar interbody fusion with three SynCages over L1-2, L2-3, and L3-4, the scoliotic angle (T12-L4) was improved from 37° to 17° (C) and the lumbar lordotic curve was improved from 4° to 29° (D). One week later, posterior instrumentation of T12-S1 with posterior interbody fusion of L5-S1 was performed. The scoliotic angle was improved from 17° to 6° (E) and the lumbar lordotic curve was improved from 29° to 36° (F).

Mentions: From November 2002 to November 2011, 1834 patients with degenerative lumbar scoliosis underwent surgery in our institution. The Chang Gung Medical Foundation Institutional Review Board approved this study (99-0771B) and waived the requirement for informed consent due to the retrospective nature of the study. All patients presented with neurological claudication with mechanical back pain that was refractory to at least 6 months of conservative management such as physical therapy, activity modification, chiropractic manipulation, administration of oral analgesics and nonsteroidal anti-inflammatory drugs, epidural steroids, and facet injections. The inclusion criteria of combined anterior and posterior approach were (1) rigid or frank lumbar kyphosis, (2) anterior or lateral bridged traction vertebral osteophytes, (3) gross coronal and sagittal deformity or imbalance, and (4) severe disc space narrowing that is not identifiable when performing PLIF or TLIF (Figure 1) and exclusion criteria were previous abdominal or retroperitoneal surgery.Figure 1


Combined anterior lumbar interbody fusion and instrumented posterolateral fusion for degenerative lumbar scoliosis: indication and surgical outcomes.

Hsieh MK, Chen LH, Niu CC, Fu TS, Lai PL, Chen WJ - BMC Surg (2015)

A 64-year-old woman complained low back pain with bilateral sciatica and claudication for several years. Radiographs of anteroposterior view (A) and lateral view (B) showing degenerative lumbar scoliosis from T12 to L5 with lateral bridged traction vertebral osteophytes over L2-3,L3-4 associated with severe disc space narrowing over L1-2 ,L2-3. After anterior lumbar interbody fusion with three SynCages over L1-2, L2-3, and L3-4, the scoliotic angle (T12-L4) was improved from 37° to 17° (C) and the lumbar lordotic curve was improved from 4° to 29° (D). One week later, posterior instrumentation of T12-S1 with posterior interbody fusion of L5-S1 was performed. The scoliotic angle was improved from 17° to 6° (E) and the lumbar lordotic curve was improved from 29° to 36° (F).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4374402&req=5

Fig1: A 64-year-old woman complained low back pain with bilateral sciatica and claudication for several years. Radiographs of anteroposterior view (A) and lateral view (B) showing degenerative lumbar scoliosis from T12 to L5 with lateral bridged traction vertebral osteophytes over L2-3,L3-4 associated with severe disc space narrowing over L1-2 ,L2-3. After anterior lumbar interbody fusion with three SynCages over L1-2, L2-3, and L3-4, the scoliotic angle (T12-L4) was improved from 37° to 17° (C) and the lumbar lordotic curve was improved from 4° to 29° (D). One week later, posterior instrumentation of T12-S1 with posterior interbody fusion of L5-S1 was performed. The scoliotic angle was improved from 17° to 6° (E) and the lumbar lordotic curve was improved from 29° to 36° (F).
Mentions: From November 2002 to November 2011, 1834 patients with degenerative lumbar scoliosis underwent surgery in our institution. The Chang Gung Medical Foundation Institutional Review Board approved this study (99-0771B) and waived the requirement for informed consent due to the retrospective nature of the study. All patients presented with neurological claudication with mechanical back pain that was refractory to at least 6 months of conservative management such as physical therapy, activity modification, chiropractic manipulation, administration of oral analgesics and nonsteroidal anti-inflammatory drugs, epidural steroids, and facet injections. The inclusion criteria of combined anterior and posterior approach were (1) rigid or frank lumbar kyphosis, (2) anterior or lateral bridged traction vertebral osteophytes, (3) gross coronal and sagittal deformity or imbalance, and (4) severe disc space narrowing that is not identifiable when performing PLIF or TLIF (Figure 1) and exclusion criteria were previous abdominal or retroperitoneal surgery.Figure 1

Bottom Line: At the final follow-up, the mean ODI score improved from 28.8 to 6.4, and the mean back/leg VAS, from 8.2/5.5 to 2.1/0.9 in AP group and the mean ODI score improved from 29.1 to 6.2, and the mean back/leg VAS, from 9.0/6.5 to 2.3/0.5 in P group.The mean scoliotic angle changed from 41.3° preoperatively to 9.3°, and the lumbar lordotic angle, from 3.1° preoperatively to 35.7° in AP group and the mean scoliotic angle from 38.5 to 21.4 and the lumbar lordotic angle from 6 to 15.8 in P group.There were significant differences in sagittal (P = 0.009) and coronal (P = 0.02) plane correction between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin Street, Kweishan Shiang, Taoyuan, 333, Taiwan. stock-best@yahoo.com.tw.

ABSTRACT

Background: Traditional approaches to deformity correction of degenerative lumbar scoliosis include anterior-posterior approaches and posterior-only approaches. Most patients are treated with posterior-only approaches because the high complication rate of anterior approach. Our purpose is to compare and assess outcomes of combined anterior lumbar interbody fusion and instrumented posterolateral fusion with posterior alone approach for degenerative lumbar scoliosis with spinal stenosis.

Methods: Between November 2002 and November 2011, a total of 110 patients with degenerative spinal deformity and curves measuring over 30° were included. Of the 110 patients who underwent surgery, 56 underwent the combined anterior and posterior approach and 54 underwent posterior surgery at our institution. The following were the indications of anterior lumbar interbody fusion: (1) rigid or frank lumbar kyphosis, (2) anterior or lateral bridged traction osteophytes, (3) gross coronal and sagittal deformity or imbalance, and (4) severe disc space narrowing that is not identifiable when performing posterior or transforaminal lumbar interbody fusion. The clinical outcomes were evaluated using the Oswestry disability index and the visual analog scale. The status of fusion were assessed according to the radiographic findings.

Results: All patients received clinical and radiographic follow-up for a minimum of 24 months, with an average follow-up of 53 months (range, 26-96 months). At the final follow-up, the mean ODI score improved from 28.8 to 6.4, and the mean back/leg VAS, from 8.2/5.5 to 2.1/0.9 in AP group and the mean ODI score improved from 29.1 to 6.2, and the mean back/leg VAS, from 9.0/6.5 to 2.3/0.5 in P group. The mean scoliotic angle changed from 41.3° preoperatively to 9.3°, and the lumbar lordotic angle, from 3.1° preoperatively to 35.7° in AP group and the mean scoliotic angle from 38.5 to 21.4 and the lumbar lordotic angle from 6 to 15.8 in P group. There were significant differences in sagittal (P = 0.009) and coronal (P = 0.02) plane correction between the two groups.

Conclusions: Our results demonstrate that combined anterior lumbar interbody fusion and instrumented posterolateral fusion for adult degenerative lumbar scoliosis effectively improves sagittal and coronal plane alignment than posterior group and both group were effectively improves clinical scores.

No MeSH data available.


Related in: MedlinePlus