Posterior corrective surgery with a multilevel transforaminal lumbar interbody fusion and a rod rotation maneuver for patients with degenerative lumbar kyphoscoliosis

Abstract

<jats:p>The purpose of this study was to assess the clinical results of posterior corrective surgery using a multilevel transforaminal lumbar interbody fusion (TLIF) with a rod rotation (RR) and to evaluate the segmental corrective effect of a TLIF using CT imaging. The medical records of 15 consecutive patients with degenerative lumbar kyphoscoliosis (DLKS) who had undergone posterior spinal corrective surgery using a multilevel TLIF with an RR technique and who had a minimum follow-up of 2 years were retrospectively reviewed. Radiographic parameters were evaluated using plain radiographs, and segmental correction was evaluated using CT imaging. Clinical outcomes were evaluated with the Scoliosis Research Society Patient Questionnaire-22 (SRS-22) and the SF-36.</jats:p> <jats:p>The mean follow-up period was 46.7 months, and the mean age at the time of surgery was 60.7 years. The mean total SRS-22 score was 2.9 before surgery and significantly improved to 4.0 at the latest follow-up. The physical functioning, role functioning (physical), and social functioning subcategories of the SF-36 were generally improved at the latest follow-up, although the changes in these scores were not statistically significant. The bodily pain, vitality, and mental health subcategories were significantly improved at the latest follow-up (p &lt; 0.05).</jats:p> <jats:p>Three complications occurred in 3 patients (20%). The Cobb angle of the lumbar curve was reduced to 20.3° after surgery. The overall correction rate was 66.4%. The pelvic incidence–lumbar lordosis (preoperative/postoperative = 31.5°/4.3°), pelvic tilt (29.2°/18.9°), and sagittal vertical axis (78.3/27.6 mm) were improved after surgery and remained so throughout the follow-up. Computed tomography image analysis suggested that a 1-level TLIF can result in 10.9° of scoliosis correction and 6.8° of lordosis.</jats:p> <jats:p>Posterior corrective surgery using a multilevel TLIF with an RR on patients with DLKS can provide effective correction in the coronal plane but allows only limited sagittal correction.</jats:p>

The patterns of loss of correction after posterior wedge osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis: a minimum of five-year follow-up

“…Thus, it should be emphasized that examination of ESR and CRP level and application of anti-inflammation medication should be regularly performed for AS patients without fully ossified bridging syndesmophytes during the follow-up period to prevent the loss of correction [ 23 , 24 ]. Nevertheless, the above-mentioned results were not completely in accordance with the conclusions reported by several previous studies in adult spinal deformity (ASD) [ 9 – 11 ]. In a study of 183 ASD patients reported by Theologis et al [ 11 ], the instrumented lumbar levels were assumed to be the primary cause for loss of lumbar sagittal correction in long adult deformity constructs.…”

Orientation of L4 coronal tilt relative to C7 plumb line as a predictor for postoperative coronal imbalance in patients with degenerative lumbar scoliosis

“…Coronal horizontalization of L4 reflects the magnitude of correction in fractional curve, it is of great importance during correction of coronal imbalance in patients with coronal consistency pattern, which can provide a leveled foundation to facilitate the correction of the curve(s) above L4. Posterior column osteotomy in the lumbosacral fractional curve plus TLIFs (L5S1, L4/5) could provide effective correction to achieve the coronal horizontalization of L4 15 . On the other hand, in patients with coronal opposition pattern, coronal horizontalization of L4 does not seem as critical as in patients with coronal consistency pattern.…”

Changes in human intervertebral disc biochemical composition and bony end plates between middle and old age

“…However, in other disorders such as fractures or spondylolisthesis, where minimally invasive surgery is used as the means of treatment, for these to succeed, it is absolutely necessary that the disc remains healthy. However, disc degeneration is also implicated in the development of spinal pathologies which affect the elderly in particular, such as spinal stenosis[ 50 ] and kyphoscoliosis[ 51 ]. With the increase in numbers of the elderly, and the growing incidence of spinal problems in this population, the results of this study show that more attention needs to be given to factors leading to degenerative changes in the disc, not only in middle age but right throughout life.…”