Choi Seung Won, Ames Christopher, Berven Sigurd, Chou Dean, Tay Bobby, Deviren Vedat
Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Korea.
Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA.
J Korean Neurosurg Soc. 2018 Nov;61(6):716-722. doi: 10.3340/jkns.2017.0275. Epub 2018 Oct 30.
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.
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).
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 followup, there were significant improvements in VAS, SF-36 Physical Component Summary and ODI scores.
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.
外侧椎间融合术（LIF）作为一种治疗成人脊柱畸形时处理脊柱前路病变的微创技术颇具吸引力。其在成人退变性脊柱侧凸治疗中的自身用途及益处尚不明确。为研究LIF以及分期LIF与后路脊柱融合术（PSF）治疗成人退变性脊柱侧凸患者的影像学和临床疗效，我们分析了接受LIF和后路脊柱融合术的成人退变性脊柱侧凸患者的影像学和临床疗效。
回顾性分析在单一机构接受LIF并分期行PSF的40例连续成人退变性脊柱侧凸患者。术前、分期时、术后3个月、1年和2年拍摄长期留存的36英寸前后位和侧位X线片。通过视觉模拟量表（VAS）、36项简明健康调查量表（SF - 36）和Oswestry功能障碍指数（ODI）评估疗效。
40例患者符合纳入标准，平均年龄66.3岁（范围49 - 79岁）。LIF平均融合3.8个节段（范围2 - 5个节段），而后路手术平均融合9.0个节段（范围3 - 16个节段）。分期之间的平均时间为1.4天（范围1 - 6天）。平均随访时间为19.6个月。腰椎前凸从术前的36.4°显著恢复至LIF术后的48.9°（占总矫正量的71.4%）和PSF术后的53.9°。腰椎冠状面Cobb角从术前的38.6°显著改善至LIF术后的24.1°（占总矫正量的55.8%），PSF术后为12.6°。平均骨盆入射角 - 腰椎前凸失配从术前的22.2°显著改善至LIF术后的8.1°（占总矫正量的86.5%），PSF术后为5.9°。冠状面失衡和矢状位脊柱轴线的矫正未达到显著水平。围手术期并发症发生率为37.5%。5例患者因伤口感染接受了翻修手术。未发生重大围手术期医疗并发症。在最后随访时，VAS、SF - 36身体成分总结和ODI评分有显著改善。
LIF能使成人退变性脊柱侧凸患者在冠状面和矢状面得到显著矫正。然而，LIF联合分期PSF在治疗成人退变性脊柱侧凸时能提供更优异的影像学和临床疗效，并降低围手术期风险。
