Flouzat-Lachaniette Charles-Henri, Ratte Louis, Poignard Alexandre, Auregan Jean-Charles, Queinnec Steffen, Hernigou Philippe, Allain Jérôme
Hôpital Henri Mondor (AP-HP-UPEC), Institut du Rachis, Service de Chirurgie Orthopédique et Traumatologique, Créteil, France.
J Neurosurg Spine. 2015 Dec;23(6):739-46. doi: 10.3171/2015.3.SPINE14772. Epub 2015 Aug 28.
Frequent complications of posterolateral instrumented fusion have been reported after treatment of degenerative scoliosis in elderly patients. Considering that in some cases, most of the symptomatology of adult degenerative scoliosis (ADS) is a consequence of the segmental instability at the dislocated level, the use of minimally invasive anterior lumbar interbody fusion (ALIF) to manage symptoms can be advocated to reduce surgical morbidity. The purpose of this study was to evaluate the midterm outcomes of 1- or 2-level minimally invasive ALIFs in ADS patients with 1- or 2-level dislocations.
A total of 47 patients (average age 64 years; range 43-80 years) with 1- or 2-level ALIF performed for ADS (64 levels) in a single institution were included in the study. An independent spine surgeon retrospectively reviewed all the patients' medical records and radiographs to assess operative data and surgery-related complications. Clinical outcome was reported using the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for lumbar and leg pain. Intraoperative data and complications were collected. Fusion and risk for adjacent-level degeneration were assessed.
The mean follow-up duration was 3 years (range 1-10 years). ODI, and back and leg pain VAS scores were significantly improved at last follow-up. A majority of patients (74%) had a statistically significant improvement in their ODI score of more than 20 points at latest follow-up and 1 had a worsening of his disability. The mean operating time was 166 minutes (range 70-355 minutes). The mean estimated blood loss was 410 ml (range 50-1700 ml). Six (5 major and 1 minor) surgical complications (12.7% of patients) and 13 (2 major and 11 minor) medical complications (27.7% of patients) occurred without death or wound infection. Fusion was achieved in 46 of 47 patients. Surgery resulted in a slight but significant decrease of the Cobb angle, and improved the pelvic parameters and lumbar lordosis, but had no effect on the global sagittal balance. At latest follow-up, 9 patients (19.1%) developed adjacent-segment disease at a mean of 2 years' delay from the index surgery; 4 were symptomatic but treated medically, and none required iterative surgery.
Single- or 2-level minimally invasive fusion through a minimally invasive anterior approach in some selected cases of ADS produced a good functional outcome with a high fusion rate. They were associated with a significantly lower rate of complications in this study than the historical control.
据报道，老年患者退行性脊柱侧弯治疗后，后路器械融合术常出现并发症。考虑到在某些情况下，成人退行性脊柱侧弯（ADS）的大部分症状是脱位节段节段性不稳定的结果，可提倡采用微创前路腰椎椎间融合术（ALIF）来控制症状，以降低手术发病率。本研究的目的是评估1或2节段脱位的ADS患者行1或2节段微创ALIF的中期疗效。
本研究纳入了在单一机构中因ADS行1或2节段ALIF（共64节段）的47例患者（平均年龄64岁；范围43 - 80岁）。一名独立的脊柱外科医生回顾性地查阅了所有患者的病历和X线片，以评估手术数据和与手术相关的并发症。使用Oswestry功能障碍指数（ODI）和视觉模拟量表（VAS）对腰部和腿部疼痛进行临床疗效报告。收集术中数据和并发症情况。评估融合情况及相邻节段退变风险。
平均随访时间为3年（范围1 - 10年）。末次随访时，ODI以及腰部和腿部疼痛的VAS评分均显著改善。大多数患者（74%）在末次随访时ODI评分有统计学意义的改善，提高超过20分，1例患者功能障碍加重。平均手术时间为166分钟（范围70 - 355分钟）。平均估计失血量为410毫升（范围50 - 1700毫升）。发生了6例（5例严重和1例轻微）手术并发症（占患者的12.7%）和13例（2例严重和11例轻微）医疗并发症（占患者的27.7%），无死亡或伤口感染情况。47例患者中有46例实现了融合。手术使Cobb角略有但显著减小，改善了骨盆参数和腰椎前凸，但对整体矢状面平衡无影响。在末次随访时，9例患者（19.1%）发生了相邻节段疾病，距初次手术平均延迟2年；4例有症状但接受了保守治疗，无一例需要再次手术。
在部分选定的ADS病例中，通过微创前路进行单节段或2节段微创融合术可产生良好的功能结局，融合率高。在本研究中，与历史对照相比，其并发症发生率显著更低。
