Posterior Only Versus Combined Anterior and Posterior Approaches to Lumbar Scoliosis in Adults

Pateder, Dhruv B.; Kebaish, Khaled M.; Cascio, Brett M.; Neubaeur, Phillip; Matusz, David; Kostuik, John P.

doi:10.1097/brs.0b013e318067dc0e

Cited by 85 publications

(51 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…19 Placement of grafts via a lateral approach allows for preservation of the anterior longitudinal ligament, and has been shown in cadaver studies to be biomechanically equivalent to grafts placed via an anterior approach. 8 Pateder and colleagues, 16 in a large series of patients, showed comparable outcomes in curve correction for those undergoing A/P or posterior-only correction. They achieved 54% correction in the posterior-only group and 46% correction in the A/P group.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional approaches to deformity correction include A/P approaches and posterior-only approaches, both of which have been shown to be effective. 5,16 However, the anterior approach is associated with complications such as vascular injury, ileus, and retrograde ejaculation. 21 Posterior approaches (PLIF and TLIF) place the nerve roots and thecal sac at greater risk because these structures must necessarily be exposed, and then protected, during graft insertion.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation

Tormenti¹,

Maserati²,

Bonfield³

et al. 2010

FOC

251

180

View full text Add to dashboard Cite

Object The authors recently used a combined approach of minimally invasive transpsoas extreme lateral interbody fusion (XLIF) and open posterior segmental pedicle screw instrumentation with transforaminal lumbar interbody fusion (TLIF) for the correction of coronal deformity. The complications and radiographic outcomes were compared with a posterior-only approach for scoliosis correction. Methods The authors retrospectively reviewed all deformity cases that were surgically corrected at the University of Pittsburgh Medical Center Presbyterian Hospital between June 2007 and August 2009. Eight patients underwent combined transpsoas and posterior approaches for adult degenerative thoracolumbar scoliosis. The comparison group consisted of 4 adult patients who underwent a posterior-only scoliosis correction. Data on intra- and postoperative complications were collected. The pre- and postoperative posterior-anterior and lateral scoliosis series radiographic films were reviewed, and comparisons were made for coronal deformity, apical vertebral translation (AVT), and lumbar lordosis. Clinical outcomes were evaluated by comparing pre- and postoperative visual analog scale scores. Results The median preoperative coronal Cobb angle in the combined approach was 38.5° (range 18–80°). Following surgery, the median Cobb angle was 10° (p < 0.0001). The mean preoperative AVT was 3.6 cm, improving to 1.8 cm postoperatively (p = 0.031). The mean preoperative lumbar lordosis in this group was 47.3°, and the mean postoperative lordosis was 40.4°. Compared with posterior-only deformity corrections, the mean values for curve correction were higher for the combined approach than for the posterior-only approach. Conversely, the mean AVT correction was higher in the posterior-only group. One patient in the posterior-only group required revision of the instrumentation. One patient who underwent the transpsoas XLIF approach suffered an intraoperative bowel injury necessitating laparotomy and segmental bowel resection; this patient later underwent an uneventful posterior-only correction of her scoliotic deformity. Two patients (25%) in the XLIF group sustained motor radiculopathies, and 6 of 8 patients (75%) experienced postoperative thigh paresthesias or dysesthesias. Motor radiculopathy resolved in 1 patient, but persisted 3 months postsurgery in the other. Sensory symptoms persisted in 5 of 6 patients at the most recent follow-up evaluation. The mean clinical follow-up time was 10.5 months for the XLIF group and 11.5 months for the posterior-only group. The mean visual analog scale score decreased from 8.8 to 3.5 in the XLIF group, and it decreased from 9.5 to 4 in the posterior-only group. Conclusions Radiographic outcomes such as the Cobb angle and AVT were significantly improved in patients who underwent a combined transpsoas and posterior approach. Lumbar lordosis was maintained in all patients undergoing the combined approach. The combination of XLIF and TLIF/posterior segmental instrumentation techniques may lead to less blood loss and to radiographic outcomes that are comparable to traditional posterior-only approaches. However, the surgical technique carries significant risks that require further evaluation and proper informed consent.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation

Tormenti¹,

Maserati²,

Bonfield³

et al. 2010

FOC

251

180

View full text Add to dashboard Cite

show abstract

“…Osteotomies are often used to restore lumbar lordosis and correct the overall sagittal balance for patients with DLS. 1,6,[8][9][10][11][12]14,15,20,22,23,32,34,37,38,42 Posterior fusion is often used following osteotomies.…”

confidence: 99%

Minimally invasive spine surgery for adult degenerative lumbar scoliosis

Dangelmajer

Zadnik

Rodríguez

et al. 2014

FOC

View full text Add to dashboard Cite

Object Historically, adult degenerative lumbar scoliosis (DLS) has been treated with multilevel decompression and instrumented fusion to reduce neural compression and stabilize the spinal column. However, due to the profound morbidity associated with complex multilevel surgery, particularly in elderly patients and those with multiple medical comorbidities, minimally invasive surgical approaches have been proposed. The goal of this meta-analysis was to review the differences in patient selection for minimally invasive surgical versus open surgical procedures for adult DLS, and to compare the postoperative outcomes following minimally invasive surgery (MIS) and open surgery. Methods In this meta-analysis the authors analyzed the complication rates and the clinical outcomes for patients with adult DLS undergoing complex decompressive procedures with fusion versus minimally invasive surgical approaches. Minimally invasive surgical approaches included decompressive laminectomy, microscopic decompression, lateral and extreme lateral interbody fusion (XLIF), and percutaneous pedicle screw placement for fusion. Mean patient age, complication rates, reoperation rates, Cobb angle, and measures of sagittal balance were investigated and compared between groups. Results Twelve studies were identified for comparison in the MIS group, with 8 studies describing the lateral interbody fusion or XLIF and 4 studies describing decompression without fusion. In the decompression MIS group, the mean preoperative Cobb angle was 16.7° and mean postoperative Cobb angle was 18°. In the XLIF group, mean pre- and postoperative Cobb angles were 22.3° and 9.2°, respectively. The difference in postoperative Cobb angle was statistically significant between groups on 1-way ANOVA (p = 0.014). Mean preoperative Cobb angle, mean patient age, and complication rate did not differ between the XLIF and decompression groups. Thirty-five studies were identified for inclusion in the open surgery group, with 18 studies describing patients with open fusion without osteotomy and 17 papers detailing outcomes after open fusion with osteotomy. Mean preoperative curve in the open fusion without osteotomy and with osteotomy groups was 41.3° and 32°, respectively. Mean reoperation rate was significantly higher in the osteotomy group (p = 0.008). On 1-way ANOVA comparing all groups, there was a statistically significant difference in mean age (p = 0.004) and mean preoperative curve (p = 0.002). There was no statistically significant difference in complication rates between groups (p = 0.28). Conclusions The results of this study suggest that surgeons are offering patients open surgery or MIS depending on their age and the severity of their deformity. Greater sagittal and coronal correction was noted in the XLIF versus decompression only MIS groups. Larger Cobb angles, greater sagittal imbalance, and higher reoperation rates were found in studies reporting the use of open fusion with osteotomy. Although complication rates did not significantly differ between groups, these data are difficult to interpret given the heterogeneity in reporting complications between studies.

show abstract

“…1). Treatments to address both sagittal and coronal plane deformities have included extensive anterior release combined with posterior spinal instrumentation and fusion [1]. When this does not provide enough mobility to correct these rigid deformities, osteotomies may be required, even in multilevel revision cases [2,3].…”

Section: Introductionmentioning

confidence: 99%

Additional sagittal correction can be obtained when using an expandable titanium interbody device in lumbar Smith-Peterson osteotomies: a biomechanical study

et al. 2015

View full text Add to dashboard Cite

Posterior Only Versus Combined Anterior and Posterior Approaches to Lumbar Scoliosis in Adults

Abstract: When combined with extensive posterior releases, posterior only approach is just as effective as combined anterior and posterior surgery for adult lumbar scoliosis measuring between 40 degrees and 70 degrees .

Cited by 85 publications

References 10 publications

Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation

Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation

Minimally invasive spine surgery for adult degenerative lumbar scoliosis

Additional sagittal correction can be obtained when using an expandable titanium interbody device in lumbar Smith-Peterson osteotomies: a biomechanical study

Contact Info

Product

Resources

About