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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

Line chart of scoliotic angle correction compared with lordotic angle correction.
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Fig2: Line chart of scoliotic angle correction compared with lordotic angle correction.

Mentions: Preoperative and postoperative coronal Cobb angles and lumbar lordosis angles were compared (Table 1). The average preoperative coronal Cobb angle was 41.3° (range, 32°–85°), which decreased to 9.3° post-operatively in AP group, demonstrating a significant mean scoliosis correction of 78% (P = 0.042). The mean preoperative lumbar lordosis angle increased from 3.1° (range, kyphosis 30° to lordosis 33°) to 35.7° (range, lordosis 9° to 60°), demonstrating a mean improvement of 32.6° (P = 0.009).In P group , the average preoperative coronal Cobb angle was 38.5° (range, 32°–55°), which decreased to 21.4° post-operatively, demonstrating a significant mean scoliosis correction of 44%. The mean preoperative lumbar lordosis angle increased from 6° (range, kyphosis 25° to lordosis 25°) to 15.8° (range, lordosis 10° to 40°), demonstrating a mean improvement of 9.8°. Both in coronal and sagittal plane ,angle improvement were better in AP group than P group.As shown in Table 2, ALIF was performed for a total of 171 disc levels in the 56 patients as follows: 1-level procedure (n = 3), 2-level (n = 15), 3-level (n = 18), 4-level (n = 16), and 5-level (n = 4). As seen in Figure 2, the ALIF procedures were correlated with a higher rate of scoliosis and lordosis correction. In Figure 3 and Table 3, an ALIF cage placed in the posterior half provides more lordosis at the instrumented level, whereas a cage placed in the anterior half may not provide better sagittal plane correction. (10.9° to 6.1°; P = 0.0058). Two patients exhibited asymptomatic SynCage subsidence, and 1 patient had asymptomatic S1 screw loosening. The fusion status was decided by the senior surgeons (W-J,Chen). At the final follow-up, 36 of the 56 patients (64.3%) exhibited solid anterior fusion; 40 (71.4%), solid posterolateral fusion; 20 (35.7%), probable anterior fusion; and 16 (28.6%), probable posterolateral fusion in AP group and 39 of the 54 patients (72.2%) exhibited solid posterolateral fusion; 15 (27.8%), probable posterolateral fusion in P group. No anterior or posterolateral pseudoarthrosis was noted.Table 2


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)

Line chart of scoliotic angle correction compared with lordotic angle correction.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Line chart of scoliotic angle correction compared with lordotic angle correction.
Mentions: Preoperative and postoperative coronal Cobb angles and lumbar lordosis angles were compared (Table 1). The average preoperative coronal Cobb angle was 41.3° (range, 32°–85°), which decreased to 9.3° post-operatively in AP group, demonstrating a significant mean scoliosis correction of 78% (P = 0.042). The mean preoperative lumbar lordosis angle increased from 3.1° (range, kyphosis 30° to lordosis 33°) to 35.7° (range, lordosis 9° to 60°), demonstrating a mean improvement of 32.6° (P = 0.009).In P group , the average preoperative coronal Cobb angle was 38.5° (range, 32°–55°), which decreased to 21.4° post-operatively, demonstrating a significant mean scoliosis correction of 44%. The mean preoperative lumbar lordosis angle increased from 6° (range, kyphosis 25° to lordosis 25°) to 15.8° (range, lordosis 10° to 40°), demonstrating a mean improvement of 9.8°. Both in coronal and sagittal plane ,angle improvement were better in AP group than P group.As shown in Table 2, ALIF was performed for a total of 171 disc levels in the 56 patients as follows: 1-level procedure (n = 3), 2-level (n = 15), 3-level (n = 18), 4-level (n = 16), and 5-level (n = 4). As seen in Figure 2, the ALIF procedures were correlated with a higher rate of scoliosis and lordosis correction. In Figure 3 and Table 3, an ALIF cage placed in the posterior half provides more lordosis at the instrumented level, whereas a cage placed in the anterior half may not provide better sagittal plane correction. (10.9° to 6.1°; P = 0.0058). Two patients exhibited asymptomatic SynCage subsidence, and 1 patient had asymptomatic S1 screw loosening. The fusion status was decided by the senior surgeons (W-J,Chen). At the final follow-up, 36 of the 56 patients (64.3%) exhibited solid anterior fusion; 40 (71.4%), solid posterolateral fusion; 20 (35.7%), probable anterior fusion; and 16 (28.6%), probable posterolateral fusion in AP group and 39 of the 54 patients (72.2%) exhibited solid posterolateral fusion; 15 (27.8%), probable posterolateral fusion in P group. No anterior or posterolateral pseudoarthrosis was noted.Table 2

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