A hybrid therapeutic approach for decreasing postoperative complications in patients with adult lumbar degenerative scoliosis

Abstract

To decrease postoperative complications in patients with adult lumbar degenerative scoliosis (ALDS), short-segment fusion surgery was used in this study. However, the incidence of adjacent segment disease was found to be remarkable. Therefore, we applied the hybrid treatment (short-segment fusion for responsibility levels plus nonfusion stabilization of lumbar segments, which was called the Wallis system, for the proximal level) to patients enrolled into this study. The purpose of this study was to investigate the feasibility of a novel hybrid therapeutic approach for treating patients with ALDS. From January 2011 to January 2017, a retrospective study was conducted consisting of 16 patients with ALDS who were treated with hybrid treatment. All patients were treated with short-segment decompression and fusion for responsibility levels and nonfusion stabilization of lumbar segments for the proximal levels. The imaging outcomes were evaluated preoperatively and at the time of follow-up. The mean visual analog score for back pain decreased from 6.1 ± 2.0 preoperatively to 2.1 ± 0.7 at 2-year follow-up ( P < .05), and the mean visual analog score for leg pain reduced from 8.1 ± 0.6 preoperatively to 1.3 ± 0.8 at 2-year follow-up ( P < .05). The Oswestry disability index scores improved from 65.4 ± 16.3% preoperatively to 18.3 ± 5.6% at 2-year follow-up ( P < .05). The mean Cobb angle was 22.1 ± 6.2° preoperatively, and 13.8 ± 6.8° at 2-year follow-up ( P < .05). The lumbar lordosis changed from −40.4 ± 14.8° to −43.5 ± 11.2° at 2-year follow-up ( P < .05). Solid fusion was achieved in all the patients, and no incidence of adjacent segment disease was noted as well. The proposed hybrid treatment for patients with ALDS can achieve favorable clinical outcomes and a lower incidence of ALDS. However, the correction of deformity is still limited that highlights the necessity of further study.

Limited Intervention in Adult Scoliosis—A Systematic Review

“…Subsequently, Di Silvestre et al examined the usage of the Dynesys system in adult degenerative scoliosis, reporting statistically significant improvements in ODI, RMDQ, and VAS scores for leg pain and back pain, along with statistically significant corrections in scoliosis Cobb angle and anterior vertebral translation [48]. Zhao et al examined short-segment instrumented fusion with proximal dynamic stabilization with the Wallis system, an interspinous spacer and a fixator and noted improvements in ODI and VAS scores along with no adjacent segment disease cephalad to fusion, but also noted limited radiographic correction [49]. Given the relatively small body of literature, with limitations in statistical power, regarding the usage of dynamic fixation in adult deformity, no concrete conclusions can be drawn regarding its efficacy.…”