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

Scheufler, Kai-Michael; Cyron, Donatus; Dohmen, Hildegard; Eckardt, Anke

doi:10.1227/neu.0b013e3181f918cf

Cited by 25 publications

(14 citation statements)

References 87 publications

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“…Cumulative radiation dose can exceed regulatory occupational limits[25],[26]. With current CT and 3-dimensional fluoroscopy-based navigation systems, the patient is exposed to significant amounts of radiation during image acquisition even if the surgeon is able to step away[18],[27]. This study confirmed that the use of the “L” shaped measuring device significantly reduced fluoroscopy time.…”

Section: Discussionsupporting

confidence: 71%

A new free-hand pedicle screw placement technique with reference to the supraspinal ligament

Li¹,

Zhao²,

Xie³

et al. 2014

J Biomed Res

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We sought to compare the safety and accuracy of a new free-hand pedicle screw placement technique to that of the conventional technique. One hundred fifty-three consecutive adult patients with simple fracture in the thoracic or/and lumbar spine were alternately assigned to either the new free-hand or the conventional group. In the new free-hand technique group, preoperative computerized tomography (CT) images were used to calculate the targeted medial-lateral angle of each pedicle trajectory and the pedicle screw was inserted perpendicular to the correspond-ing supraspinal ligament. In the conventional technique group, the medial-lateral and cranial-caudal angle of each pedicle trajectory was determined by intraoperatively under fluoroscopic guidance. The accuracy rate of pedicle screw placement, the time of intraoperative fluoroscopy, the operating time and the amount of blood loss during operation were respectively compared. All screws were analyzed by using intraoperative radiographs, intraoperative triggered electromyography (EMG) monitoring data, postoperative CT data and clinical outcomes. The accuracy rate of pedicle screw placement in the new free-hand technique group and the conventional technique group was 96.3% and 94.2% (P < 0.05), respectively. The intraoperative fluoroscopy time of the new technique group was less than that of the conventional technique group (5.37 seconds vs. 8.79 seconds, P < 0.05). However, there was no statistical difference in the operating time and the amount of blood loss during operation (P > 0.05). Pedicle screw placement with the free-hand technique which keeps the screw perpendicular to the supraspinal ligament is an accurate, reliable and safe technique to treat simple fracture in the thoracic or lumbar spine.

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Section: Discussionsupporting

confidence: 71%

A new free-hand pedicle screw placement technique with reference to the supraspinal ligament

Li¹,

Zhao²,

Xie³

et al. 2014

J Biomed Res

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“…10,18,29,33,44,45,56 However, the utility of this technique in the treatment of spinal deformity, specifically with respect to adult degenerative scoliosis, has not been formally evaluated in greater detail. 2,3,10,11,18,31,34,46,47,56,60 With release of the lateral annuli, distraction across the disc space, and placement of a large interbody graft across the entire length of the endplates, the minimally invasive LLIF approach has become a powerful tool in the armamentarium in spinal deformity correction procedures. Indeed, when combined with PSIF, it has been reported to be effective in providing varying degrees of correction of degenerative lumbar scoliotic curves with less blood loss and less morbidity than traditional open procedures.…”

Section: Discussionmentioning

confidence: 99%

Radiographic and clinical outcomes following combined lateral lumbar interbody fusion and posterior segmental stabilization in patients with adult degenerative scoliosis

Tempel¹,

Gandhoke²,

Bonfield³

et al. 2014

FOC

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Object A hybrid approach of minimally invasive lateral lumbar interbody fusion (LLIF) followed by supplementary open posterior segmental instrumented fusion (PSIF) has shown promising early results in the treatment of adult degenerative scoliosis. Studies assessing the impact of this combined approach on correction of segmental and regional coronal angulation, sagittal realignment, maximum Cobb angle, restoration of lumbar lordosis, and clinical outcomes are needed. The authors report their results of this approach for correction of adult degenerative scoliosis. Methods Twenty-six patients underwent combined LLIF and PSIF in a staged fashion. The patient population consisted of 21 women and 5 men. Ages ranged from 40 to 77 years old. Radiographic measurements including coronal angulation, pelvic incidence, lumbar lordosis, and sagittal vertical axis were taken preoperatively and 1 year postoperatively in all patients. Concurrently, the visual analog score (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and Short Form-36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were used to assess clinical outcomes in 19 patients. Results At 1-year follow-up, all patients who underwent combined LLIF and PSIF achieved statistically significant mean improvement in regional coronal angles (from 14.9° to 5.8°, p < 0.01) and segmental coronal angulation at all operative levels (p < 0.01). The maximum Cobb angle was significantly reduced postoperatively (from 41.1° to 15.1°, p < 0.05) and was maintained at follow-up (12.0°, p < 0.05). The mean lumbar lordosis–pelvic incidence mismatch was significantly improved postoperatively (from 15.0° to 6.92°, p < 0.05). Although regional lumbar lordosis improved (from 43.0° to 48.8°), it failed to reach statistical significance (p = 0.06). The mean sagittal vertical axis was significantly improved postoperatively (from 59.5 mm to 34.2 mm, p < 0.01). The following scores improved significantly after surgery: VAS for back pain (from 7.5 to 4.3, p < 0.01) and leg pain (from 5.8 to 3.1, p < 0.01), ODI (from 48 to 38, p < 0.01), and PCS (from 27.5 to 35.0, p = 0.01); the MCS score did not improve significantly (from 43.2 to 45.5, p = 0.37). There were 3 major and 10 minor complications. Conclusions A hybrid approach of minimally invasive LLIF and open PSIF is an effective means of achieving correction of both coronal and sagittal deformity, resulting in improvement of quality of life in patients with adult degenerative scoliosis.

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“…18,35,41,47,51,54 High ODI, high VAS scores, and low 12-Item Short Form Health Survey (SF-12) scores were associated with an improvement in symptoms. A baseline SF-12 score of 35 or less, for example, was 6 times more likely to improve compared with an initial score higher than 35.…”

Section: Clinical Outcomementioning

confidence: 99%

Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions

Drazin

Shirzadi²,

Rosner³

et al. 2011

FOC

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Object The elderly population (age > 60 years) is the fastest-growing age group in the US. Spinal deformity is a major problem affecting the elderly and, therefore, the demand for surgery for spinal deformity is becoming increasingly prevalent in elderly patients. Much of the literature on surgery for adult deformity focuses on patients who are younger than 60 years, and therefore there is limited information about the complications and outcomes of surgery in the elderly population. In this study, the authors undertook a review of the literature on spinal deformity surgery in patients older than 60 years. The authors discuss their analysis with a focus on outcomes, complications, discrepancies between individual studies, and strategies for complication avoidance. Methods A systematic review of the MEDLINE and PubMed databases was performed to identify articles published from 1950 to the present using the following key words: “adult scoliosis surgery” and “adult spine deformity surgery.” Exclusion criteria included patient age younger than 60 years. Data on major Oswestry Disability Index (ODI) scores, visual analog scale (VAS) scores, patient-reported outcomes, and complications were recorded. Results Twenty-two articles were obtained and are included in this review. The mean age was 74.2 years, and the mean follow-up period was 3 years. The mean preoperative ODI was 48.6, and the mean postoperative reduction in ODI was 24.1. The mean preoperative VAS score was 7.7 with a mean postoperative decrease of 5.2. There were 311 reported complications for 815 patients (38%) and 5 deaths for 659 patients (< 1%). Conclusions Elderly patient outcomes were inconsistent in the published studies. Overall, most elderly patients obtained favorable outcomes with low operative mortality following surgery for adult spinal deformity.

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

Cited by 25 publications

References 87 publications

A new free-hand pedicle screw placement technique with reference to the supraspinal ligament

A new free-hand pedicle screw placement technique with reference to the supraspinal ligament

Radiographic and clinical outcomes following combined lateral lumbar interbody fusion and posterior segmental stabilization in patients with adult degenerative scoliosis

Complications and outcomes after spinal deformity surgery in the elderly: review of the existing literature and future directions

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