Correction of adult scoliosis via a posterior-only approach

Lippman, Caleb R.; Spence, Caple A; Youssef, A. Samy; Cahill, David W.

doi:10.3171/foc.2003.14.1.6

Cited by 32 publications

(12 citation statements)

References 32 publications

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“…2,4,5,15,[17][18][19][20][21]25,32,44,50,51,56,57,59,68,78,79 However, the presence of early perioperative complications as well as late complications, such as pseudarthrosis, fixed sagittal imbalance, or painful implants, leads to reduced patient satisfaction. 14,15,23,31 Major early and late complications include major intraoperative blood loss, neurological injury, perioperative pulmonary and cardiovascular incidents, deep infection, wound breakdown, loss of fixation, local pain with iliac fixation, pseudarthrosis, proximal and distal junctional decompensation, and chronic severe back pain.…”

Section: Discussionmentioning

confidence: 97%

Less Invasive Surgical Correction of Adult Degenerative Scoliosis. Part II: Complications and Clinical Outcome

et al. 2010

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Less invasive image-guided correction of degenerative scoliosis in elderly patients with significant comorbidity yields a favorable complication profile. Significant improvements in spinal balance, pain, and functional scores mirrored expedited ambulation and early resumption of daily activities. Less invasive techniques appear suitable to reduce periprocedural morbidity, especially in elderly patients and individuals with significant medical risk factors.

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Section: Discussionmentioning

confidence: 97%

Less Invasive Surgical Correction of Adult Degenerative Scoliosis. Part II: Complications and Clinical Outcome

et al. 2010

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“…29,34,35 Effective deformity correction can often be achieved without ALIF and the associated risks, leading many authors to question its routine use in ASD. 11,20 PSO (Schwab 27 Grade 3 of 4) provides excellent sagittal correction for severe ASD, with up to 35° LL restoration and 10-cm posterior trunk translation. 32 Even in experienced hands, PSO carries significant surgical risks, both immediate (neurological deficit, durotomy) and delayed (infection, pseudarthrosis).…”

Section: Discussionmentioning

confidence: 99%

Lateral interbody fusion combined with open posterior surgery for adult spinal deformity

Strom¹,

Bae

Mizutani

et al. 2016

SPI

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OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed. Patients with < 6 months follow-up, prior fusion, severe sagittal imbalance (sagittal vertical axis > 200 mm or pelvic incidence-LL > 40°), and those undergoing anterior lumbar interbody fusion were excluded. Deformity correction, complications, and outcomes were compared between LIF+OP and OP-only surgery patients. RESULTS LIF+OP (n = 32) and OP-only patients (n = 60) had similar baseline features and posterior fusion levels. On average, 3.8 LIFs were performed. Patients who underwent LIF+OP had less blood loss (1129 vs 1833 ml, p = 0.016) and lower durotomy rates (0% vs 23%, p = 0.002). Patients in the LIF+OP group required less ICU care (0.7 vs 2.8 days, p < 0.001) and inpatient rehabilitation (63% vs 87%, p = 0.015). The incidence of new leg pain, numbness, or weakness was similar between groups (28% vs 22%, p = 0.609). All leg symptoms resolved within 6 months, except in 1 OP-only patient. Follow-up duration was similar (28 vs 25 months, p = 0.462). LIF+OP patients had significantly less pseudarthrosis (6% vs 27%, p = 0.026) and greater improvement in visual analog scale back pain (mean decrease 4.0 vs 1.9, p = 0.046) and Oswestry Disability Index (mean decrease 21 vs 12, p = 0.035) scores. Lumbar coronal correction was greater with LIF+OP surgery (mean [± SD] 22° ± 13° vs 14° ± 13°, p = 0.010). LL restoration was 22° ± 13°, intermediately between OP-only with facet osteotomies (11° ± 7°, p < 0.001) and pedicle subtraction osteotomy (29° ± 10°, p = 0.045). CONCLUSIONS LIF+OP is an effective strategy for ASD of moderate severity. Compared with the authors' OP-only operations, LIF+OP was associated with faster recovery, fewer complications, and greater relief of pain and disability.

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“…17 Although effective, the PSF-only approach has a higher reported rate of morbidity 3,6 and enables less access to the anterior vertebral body, which might compromise its ability to result in adequate spinal realignment and/or fusion. In addition, the posterior approach and placement of interbody cages via the posterior approach can be difficult when performing revision surgery in patients in whom significant scarring and bone grafting have altered the anatomy.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance

Bae

Theologis²,

Strom³

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVESurgical treatment of adult spinal deformity (ASD) is an effective endeavor that can be accomplished using a variety of surgical strategies. Here, the authors assess and compare radiographic data, complications, and health-related quality-of-life (HRQoL) outcome scores among patients with ASD who underwent a posterior spinal fixation (PSF)–only approach, a posterior approach combined with lateral lumbar interbody fusion (LLIF+PSF), or a posterior approach combined with anterior lumbar interbody fusion (ALIF+PSF).METHODSThe medical records of consecutive adults who underwent thoracolumbar fusion for ASD between 2003 and 2013 at a single institution were reviewed. Included were patients who underwent instrumentation from the pelvis to L-1 or above, had a sagittal vertical axis (SVA) of < 10 cm, and underwent a minimum of 2 years’ follow-up. Those who underwent a 3-column osteotomy were excluded. Three groups of patients were compared on the basis of the procedure performed, LLIF+PSF, ALIF+PSF, and PSF only. Perioperative spinal deformity parameters, complications, and HRQoL outcome scores (Oswestry Disability Index [ODI], Scoliosis Research Society 22-question Questionnaire [SRS-22], 36-Item Short Form Health Survey [SF-36], visual analog scale [VAS] for back/leg pain) from each group were assessed and compared with each other using ANOVA. The minimal clinically important differences used were −1.2 (VAS back pain), −1.6 (VAS leg pain), −15 (ODI), 0.587/0.375/0.8/0.42 (SRS-22 pain/function/self-image/mental health), and 5.2 (SF-36, physical component summary).RESULTSA total of 221 patients (58 LLIF, 91 ALIF, 72 PSF only) met the inclusion criteria. Average deformities consisted of a SVA of < 10 cm, a pelvic incidence–lumbar lordosis (LL) mismatch of > 10°, a pelvic tilt of > 20°, a lumbar Cobb angle of > 20°, and a thoracic Cobb angle of > 15°. Preoperative SVA, LL, pelvic incidence–LL mismatch, and lumbar and thoracic Cobb angles were similar among the groups. Patients in the PSF-only group had more comorbidities, those in the ALIF+PSF group were, on average, younger and had a lower body mass index than those in the LLIF+PSF group, and patients in the LLIF+PSF group had a significantly higher mean number of interbody fusion levels than those in the ALIF+PSF and PSF-only groups. At final follow-up, all radiographic parameters and the mean numbers of complications were similar among the groups. Patients in the LLIF+PSF group had proximal junctional kyphosis that required revision surgery significantly less often and fewer proximal junctional fractures and vertebral slips. All preoperative HRQoL scores were similar among the groups. After surgery, the LLIF+PSF group had a significantly lower ODI score, higher SRS-22 self-image/total scores, and greater achievement of the minimal clinically important difference for the SRS-22 pain score.CONCLUSIONSSatisfactory radiographic outcomes can be achieved similarly and adequately with these 3 surgical approaches for patients with ASD with mild to moderate sagittal deformity. Compared with patients treated with an ALIF+PSF or PSF-only surgical strategy, patients who underwent LLIF+PSF had lower rates of proximal junctional kyphosis and mechanical failure at the upper instrumented vertebra and less back pain, less disability, and better SRS-22 scores.

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Correction of adult scoliosis via a posterior-only approach

Cited by 32 publications

References 32 publications

Less Invasive Surgical Correction of Adult Degenerative Scoliosis. Part II: Complications and Clinical Outcome

Less Invasive Surgical Correction of Adult Degenerative Scoliosis. Part II: Complications and Clinical Outcome

Lateral interbody fusion combined with open posterior surgery for adult spinal deformity

Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance

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