scholarly journals Adult spinal deformity and its relationship with height loss: A 34-year longitudinal cohort study

2020 ◽  
Author(s):  
Mutsuya Shimizu ◽  
Tetsuya Kobayashi ◽  
Hisashi Chiba ◽  
Issei Senoo ◽  
Hiroshi Ito ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Epidemiological Studies ◽  
Height Loss ◽  
Degenerative Lumbar Scoliosis ◽  
Physical Change ◽  
Lumbar Scoliosis ◽  
Pelvic Parameters ◽  
The Mean

Abstract Background Age-related height loss is a normal physical change that occurs in all individuals over 50 years of age. Many epidemiological studies were conducted on height loss worldwide, however, over the 30 years longitudinal epidemiological studies have not been conducted. This study was designed to investigate changes in adult spinal deformity and examine the relationship between adult spinal deformity and height loss. Methods Fifty-three local healthy subjects (32 men, 21 women) from Furano, Hokkaido, Japan, volunteered for this longitudinal cohort study. Their heights were measured in 1983 and again in 2017. Spino-pelvic parameters were compared between 1983 and 2017. Individuals with height loss were then divided into two groups, those with degenerative spondylosis and those with degenerative lumbar scoliosis, and different characteristics were compared between the two groups. Results The mean age of the subjects was 44.4 (31-55) years at baseline and 78.6 (65-89) years at the final follow-up. The mean height was 157.4 cm at baseline and 153.6 cm at the final follow-up, with a mean height loss of 3.8 cm over 34.2 years. All parameters except for thoracic kyphosis were significantly different between 1983 and 2017 (p<0.05). Height loss was related to changes in pelvic parameters including pelvic incidence-lumbar lordosis (R=0.553 p<0.0001), pelvic tilt (R=0.462 p<0.0001), and sagittal vertical axis (R=0.514 p<0.0001). Greater height loss was more commonly seen in women (p=0.001) and in patients with degenerative lumbar scoliosis (p=0.02). Conclusions This longitudinal study revealed that height loss is more commonly observed in women and is associated with adult spinal deformity and degenerative lumbar scoliosis. Height loss is a normal physical change with aging, but excessive height loss is due to spinal kyphosis and scoliosis leading to spinal malalignment. Our findings suggest that height loss might be an early physical symptom for spinal malalignment.

scholarly journals Adult spinal deformity and its relationship with height loss: A 34-year longitudinal cohort study

2020 ◽  
Author(s):  
Mutsuya Shimizu ◽  
Tetsuya Kobayashi ◽  
Hisashi Chiba ◽  
Issei Senoo ◽  
Hiroshi Ito ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Epidemiological Studies ◽  
Height Loss ◽  
Degenerative Lumbar Scoliosis ◽  
Physical Change ◽  
Lumbar Scoliosis ◽  
Pelvic Parameters ◽  
The Mean

Abstract Background: Age-related height loss is a normal physical change that occurs in all individuals over 50 years of age. Although many epidemiological studies on height loss have been conducted worldwide, none have been long-term longitudinal epidemiological studies spanning over 30 years. This study was designed to investigate changes in adult spinal deformity and examine the relationship between adult spinal deformity and height loss.Methods: Fifty-three local healthy subjects (32 men, 21 women) from Furano, Hokkaido, Japan, volunteered for this longitudinal cohort study. Their heights were measured in 1983 and again in 2017. Spino-pelvic parameters were compared between measurements obtained in 1983 and 2017. Individuals with height loss were then divided into two groups, those with degenerative spondylosis and those with degenerative lumbar scoliosis, and different characteristics were compared between the two groups.Results: The mean age of the subjects was 44.4 (31-55) years at baseline and 78.6 (65-89) years at the final follow-up. The mean height was 157.4 cm at baseline and 153.6 cm at the final follow-up, with a mean height loss of 3.8 cm over 34.2 years. All parameters except for thoracic kyphosis were significantly different between measurements taken in 1983 and 2017 (p<0.05). Height loss in both sexes was related to changes in pelvic parameters including pelvic incidence-lumbar lordosis (R=0.460 p=0.008 in men, R=0.553 p=0.012 in women), pelvic tilt (R=0.374 p=0.035 in men, R=0.540 p=0.014 in women), and sagittal vertical axis (R=0.535 p=0.002 in men, R=0.527 p=0.017 in women). Greater height loss was more commonly seen in women (p=0.001) and in patients with degenerative lumbar scoliosis (p=0.02).Conclusions: This longitudinal study revealed that height loss is more commonly observed in women and is associated with adult spinal deformity and degenerative lumbar scoliosis. Height loss is a normal physical change with aging, but excessive height loss is due to spinal kyphosis and scoliosis leading to spinal malalignment. Our findings suggest that height loss might be an early physical symptom for spinal malalignment.

The influence of approach side on facet preservation in microscopic bilateral decompression via a unilateral approach for degenerative lumbar scoliosis

2010 ◽  
Vol 13 (6) ◽  
pp. 758-765 ◽  
Author(s):  
Akira Matsumura ◽  
Takashi Namikawa ◽  
Hidetomi Terai ◽  
Tadao Tsujio ◽  
Akinobu Suzuki ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Recovery Rate ◽  
Japanese Orthopaedic Association ◽  
Spinal Instability ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbar Scoliosis ◽  
Unilateral Approach ◽  
Scale Scores ◽  
The Mean

Object The authors compared the clinical outcomes of microscopic bilateral decompression via a unilateral approach (MBDU) for the treatment of degenerative lumbar scoliosis (DLS) and for lumbar canal stenosis (LCS) without instability. The authors also compared postoperative spinal instability in terms of different approach sides (concave or convex) following the procedure. Methods The authors retrospectively reviewed data obtained in 50 consecutive patients (25 in the DLS group and 25 in the LCS group) who underwent MBDU; the minimum follow-up period was 2 years. Patients with DLS were divided into 2 subgroups according to the surgical approach side: a concave group (23 segment) and a convex group (17 segments). The Japanese Orthopaedic Association Scale scores for the assessment of low-back pain were evaluated before surgery and at final follow-up. The Japanese Orthopaedic Association Scale scores and recovery rates were compared between the DLS and LCS groups, and between the convex and concave groups. Cobb angle and scoliotic wedging angle (SWA) were evaluated on standing radiographs before surgery and at final follow-up. Facet joint preservation (the percentage of preservation) was assessed on pre- and postoperative CT scans, compared between the LCS and DLS groups, and compared between the concave and convex groups. The influence of approach side on postoperative progression of segmental instability was also examined in the DLS group. Results The mean recovery rate was 58.7% in the DLS and 62.0% in the LCS group. The mean recovery rate was 58.6% in the convex group and 60.6% in the concave group. There were no significant differences in recovery rates between the LCS and DLS groups, or between the DLS subgroups. The mean Cobb angles in the DLS group were significantly increased from 12.7° preoperatively to 14.1° postoperatively (p < 0.05), and mean preoperative SWAs increased significantly from 6.2° at L3–4 and 4.1° at L4–5 preoperatively to 7.4° and 4.9°, respectively, at final follow-up (p < 0.05). There was no significant difference in percentage of preservation between the DLS and LCS groups. The mean percentages of preservation on the approach side in the DLS group at L3–4 and L4–5 were 89.0% and 83.1% in the convex group, and those in the concave group were 67.3% and 77.6%, respectively. The percentage of preservation at L3–4 was significantly higher in the convex than the concave group. The mean SWA had increased in the concave group (p = 0.01) but not the convex group (p = 0.15) at final follow-up. Conclusions The MBDU can reduce postoperative segmental spinal instability and achieve good postoperative clinical outcomes in patients with DLS. The convex approach provides surgeons with good visibility and improves preservation of facet joints.

CHALLENGING DEGENERATIVE LUMBAR SCOLIOSIS WITH SEGMENTAL CORRECTIVE FUSION SURGERY

2006 ◽  
Vol 10 (03) ◽  
pp. 141-150 ◽  
Author(s):  
Takahiro Iizuka ◽  
S. Yamada
Keyword(s):  
Spinal Curvature ◽  
Degenerative Lumbar Scoliosis ◽  
Spinal Alignment ◽  
Poor Bone Quality ◽  
Fusion Surgery ◽  
Lumbar Scoliosis ◽  
Cobb’S Angle ◽  
Correction Surgery ◽  
The Mean

Changes in the curvature have not been reported in degenerative lumbar scoliosis (DLS) when the correction surgery was performed. The purpose of our study was to clarify the influence of the correction surgery of DLS. Twenty-one patients underwent corrective lumbar reconstruction surgery (1998–2003) only at the neurologically affected levels. The spinal curvature was retrospectively evaluated in these 21 patients with DLS using Cobb's methods. The mean preoperative Cobb's angle was 17.7° while the mean postoperative Cobb's angle was 6.1° (p < 0.0001) at 1 month after the surgery and 9.0° at the final follow-up. The correction rate was 65.2% at 1 month after the surgery and 50.2% at the final follow-up. Cobb's angle increased by 2.9°/43.4 months (mean, 0.80°/year) in these procedure. The surgical goals of DLS are the relief of neurological disorders and the cessation of the deterioration of spinal alignment. Strategies for DLS may include complete decompression, or correction of the spinal alignment in elderly patients with poor bone quality. Decompression and correction in the PLIF procedure only at neurologically affected levels may be one of the surgical procedures to challenge DLS.

Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity

2014 ◽  
Vol 21 (6) ◽  
pp. 994-1003 ◽  
Author(s):  
Justin S. Smith ◽  
Ellen Shaffrey ◽  
Eric Klineberg ◽  
Christopher I. Shaffrey ◽  
Virginie Lafage ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Full Length ◽  
Consecutive Series ◽  
Inclusion Criteria ◽  
The Mean ◽  
Spine Radiographs ◽  
Rod Fracture

Object Improved understanding of rod fracture (RF) following adult spinal deformity (ASD) surgery could prove valuable for surgical planning, patient counseling, and implant design. The objective of this study was to prospectively assess the rates of and risk factors for RF following surgery for ASD. Methods This was a prospective, multicenter, consecutive series. Inclusion criteria were ASD, age > 18 years, ≥5 levels posterior instrumented fusion, baseline full-length standing spine radiographs, and either development of RF or full-length standing spine radiographs obtained at least 1 year after surgery that demonstrated lack of RF. ASD was defined as presence of at least one of the following: coronal Cobb angle ≥20°, sagittal vertical axis (SVA) ≥5 cm, pelvic tilt (PT) ≥25°, and thoracic kyphosis ≥60°. Results Of 287 patients who otherwise met inclusion criteria, 200 (70%) either demonstrated RF or had radiographic imaging obtained at a minimum of 1 year after surgery showing lack of RF. The patients' mean age was 54.8 ± 15.8 years; 81% were women; 10% were smokers; the mean body mass index (BMI) was 27.1 ± 6.5; the mean number of levels fused was 12.0 ± 3.8; and 50 patients (25%) had a pedicle subtraction osteotomy (PSO). The rod material was cobalt chromium (CC) in 53%, stainless steel (SS), in 26%, or titanium alloy (TA) in 21% of cases; the rod diameters were 5.5 mm (in 68% of cases), 6.0 mm (in 13%), or 6.35 mm (in 19%). RF occurred in 18 cases (9.0%) at a mean of 14.7 months (range 3–27 months); patients without RF had a mean follow-up of 19 months (range 12–24 months). Patients with RF were older (62.3 vs 54.1 years, p = 0.036), had greater BMI (30.6 vs 26.7, p = 0.019), had greater baseline sagittal malalignment (SVA 11.8 vs 5.0 cm, p = 0.001; PT 29.1° vs 21.9°, p = 0.016; and pelvic incidence [PI]–lumbar lordosis [LL] mismatch 29.6° vs 12.0°, p = 0.002), and had greater sagittal alignment correction following surgery (SVA reduction by 9.6 vs 2.8 cm, p < 0.001; and PI-LL mismatch reduction by 26.3° vs 10.9°, p = 0.003). RF occurred in 22.0% of patients with PSO (10 of the 11 fractures occurred adjacent to the PSO level), with rates ranging from 10.0% to 31.6% across centers. CC rods were used in 68% of PSO cases, including all with RF. Smoking, levels fused, and rod diameter did not differ significantly between patients with and without RF (p > 0.05). In cases including a PSO, the rate of RF was significantly higher with CC rods than with TA or SS rods (33% vs 0%, p = 0.010). On multivariate analysis, only PSO was associated with RF (p = 0.001, OR 5.76, 95% CI 2.01–15.8). Conclusions Rod fracture occurred in 9.0% of ASD patients and in 22.0% of PSO patients with a minimum of 1-year follow-up. With further follow-up these rates would likely be even higher. There was a substantial range in the rate of RF with PSO across centers, suggesting potential variations in technique that warrant future investigation. Due to higher rates of RF with PSO, alternative instrumentation strategies should be considered for these cases.

scholarly journals Association between bicortical screw fixation at upper instrumented vertebra and risk for upper instrumented vertebra fracture

2017 ◽  
Vol 26 (5) ◽  
pp. 638-644 ◽  
Author(s):  
Young-Seop Park ◽  
Seung-Jae Hyun ◽  
Ho Yong Choi ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng
Keyword(s):  
Spinal Deformity ◽  
Pelvic Incidence ◽  
Screw Fixation ◽  
Adult Spinal Deformity ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
The Mean ◽  
Upper Instrumented Vertebra ◽  
Bicortical Screw

OBJECTIVEThe aim of this study was to investigate the risk of upper instrumented vertebra (UIV) fractures associated with UIV screw fixation (unicortical vs bicortical) and polymethylmethacrylate (PMMA) augmentation after adult spinal deformity surgery.METHODSA single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥ 4 levels (that is, the lower instrumented vertebra at the sacrum or pelvis and the UIV of the thoracolumbar spine [T9–L2]) were retrospectively reviewed. Age, sex, follow-up duration, sagittal UIV angle immediately postoperatively including several balance-related parameters (lumbar lordosis [LL], pelvic incidence, and sagittal vertical axis), bone mineral density, UIV screw fixation type, UIV PMMA augmentation, and UIV fracture were evaluated. Patients were divided into 3 groups: Group U, 15 patients with unicortical screw fixation at the UIV; Group P, 16 with bicortical screw fixation and PMMA augmentation at the UIV; and Group B, 21 with bicortical screw fixation without PMMA augmentation at the UIV.RESULTSThe mean number of levels fused was 6.5 ± 2.5, 7.5 ± 2.5, and 6.5 ± 2.5; the median age was 50 ± 29, 72 ± 6, and 59 ± 24 years; and the mean follow-up was 31.5 ± 23.5, 13 ± 6, and 24 ± 17.5 months in Groups U, P, and B, respectively (p > 0.05). There were no significant differences in balance-related parameters (LL, sagittal vertical axis, pelvic incidence–LL, and so on) among the groups. UIV fracture rates in Groups U (0%), P (31.3%), and B (42.9%) increased in sequence by group (p = 0.006). UIV bicortical screw fixation increased the risk for UIV fracture (OR 5.39; p = 0.02).CONCLUSIONSBicortical screw fixation at the UIV is a major risk factor for early UIV compression fracture, regardless of whether a thoracolumbosacral orthosis is used. To reduce the proximal junctional failure, unicortical screw fixation at the UIV is essential in adult spinal deformity correction surgery.

Decompression and nonfusion dynamic stabilization for spinal stenosis with degenerative lumbar scoliosis

2014 ◽  
Vol 21 (4) ◽  
pp. 585-594 ◽  
Author(s):  
Soo Eon Lee ◽  
Tae-Ahn Jahng ◽  
Hyun-Jib Kim
Keyword(s):  
Spinal Stenosis ◽  
Radiolucent Line ◽  
Decompressive Surgery ◽  
Neurological Deficits ◽  
Spinal Diseases ◽  
Degenerative Lumbar Scoliosis ◽  
Moderate Degree ◽  
Lumbar Scoliosis ◽  
The Mean

Object Spinal stenosis with degenerative lumbar scoliosis (DLS) mostly occurs in the elderly population (typically > 65 years old), causing pain in the legs and back, claudication, and spinal deformity. The surgical strategy for DLS is controversial concerning the surgical approach, fusion area, decompression area, correction methods, and ideal angle of curve correction. A nonfusion stabilization system with motion preservation has been recently used for degenerative spinal diseases with favorable outcomes. This study attempted to analyze surgical outcomes after decompression and nonfusion stabilization for spinal stenosis with a mild to moderate degree of DLS. Methods Twenty-eight patients (21 women and 7 men, with a mean age of 65.3 years) with spinal stenosis and DLS who underwent decompressive surgery and nonfusion stabilization with the Dynesys system were included in this study. Medical records and radiological studies were reviewed to access clinical and radiological outcomes and surgery-related complications. Results Fifty-nine segments were decompressed and stabilized without fusion in 28 patients, consisting of 1 segmental stabilization in 8 patients (28.6%, L4–5), 2 segmental stabilizations in 11 patients (39.3%, L3–5), 3 segmental stabilizations in 7 patients (25.0%, L2–5 in 6 patients, L3–S1 in 1 patient), and 4 segmental stabilizations in 2 patients (7.1%, L2–S1 in 1 patient, L1–5 in 1 patient). The mean follow-up period was 30.7 months. Radiologically, the mean lumbar scoliotic angle was 13.7° before surgery, 5.1° at 3 months postoperatively, 3.8° at 12 months postoperatively, 4.2° at 24 months postoperatively, and 3.9° at the last follow-up, which was statistically significant (p < 0.05). Lumbar lordosis and range of motion were preserved. The score on the visual analog scale for leg and back pain significantly decreased, and the Oswestry Disability Index significantly improved after surgery. There were no newly developed neurological deficits or aggravation of neurological symptoms. A radiolucent line around the pedicle screw was observed in 4 patients (14.2%) with 5 screws (2.8%). Conclusions Adding nonfusion stabilization after decompressive surgery resulted in a safe and effective procedure for elderly patients with lumbar stenosis with a mild to moderate scoliosis angle (< 30°). Statistically significant improvement of the clinical outcome was obtained at the last follow-up evaluation with no progression of the degenerative scoliosis.

Risk of progression of degenerative lumbar scoliosis

2011 ◽  
Vol 15 (5) ◽  
pp. 558-566 ◽  
Author(s):  
Jun-Yeong Seo ◽  
Kee-Yong Ha ◽  
Tae-Hyok Hwang ◽  
Ki-Won Kim ◽  
Young-Hoon Kim
Keyword(s):  
Vertebral Body ◽  
Curve Progression ◽  
Degenerative Lumbar Scoliosis ◽  
Disc Space ◽  
Apical Vertebra ◽  
Lumbar Scoliosis ◽  
The Mean ◽  
Cobb Method ◽  
The Relationship

Object In this paper the authors' goal was to determine the factors associated with the progression of degenerative lumbar scoliosis (DLS). Methods Twenty-seven patients (3 men and 24 women; mean age 64.9 years) with more than 10° of lumbar scoliosis at baseline were monitored for a mean period of 10 years. The radiological evaluation included measurement of the scoliosis angle using the Cobb method, the direction of the scoliosis, the relationship between the intercrest line and the L-5 vertebra, lateral listhesis, segmental angle, distance from the center of the sacral line to the apical vertebra, degenerative listhesis anteriorly or posteriorly or both, and lordosis angle. In addition, the lateral osteophyte difference, disc index, and severity of osteoporosis were measured. The pain and disability outcomes were assessed using the visual analog scale and the Oswestry Disability Index (ODI) relative to severity of the angle of scoliosis. Results The mean initial and final scoliosis angles were 14° ± 5.4° and 25° ± 8.5°, respectively. The initial disc index at the L-3 vertebra (Spearman ρ = 0.7, p < 0.001), the sum of the segmental wedging angles above and below the L-3 vertebra (ρ = 0.6, p < 0.001), and the initial disc index at the apical vertebra (ρ = 0.6, p < 0.001) were correlated with the last follow-up angle of the scoliosis. By contrast, there was no statistically significant correlation between the initial segmental angles at L2–3 and L3–4 and the final follow-up scoliosis angle (ρ = 0.2, p = 0.67; and ρ = 0.1, p = 0.22; respectively). When the authors separated the patients into 3 groups according to the sum of the segmental angles above and below L-3 (< 5°, 5° to 10°, and > 10°), they found that 3 (42.9%) of 7, 8 (66.7%) of 12, and 6 (75.0%) of 8 patients in the 3 groups showed increases of greater than 10° in scoliosis angle. The mean distance from the center of the sacral line to the apical vertebra was 36.0 ± 9.7 mm, and the distance correlated with the measurement of the last follow-up angle of the scoliosis (ρ = 0.6, p < 0.001). The mean angle of the scoliosis was significantly greater when the intercrest line passed through the L-5 or L4–5 disc space than when the line passed through the L-4 vertebral body (31.4° ± 7.9° vs 21.8° ± 6.7°, p = 0.01). The ODI correlated with the measurement of the angle of the scoliosis (ρ = 0.6, p < 0.001). Age, sex, osteoporosis, the direction of the scoliosis, listhesis of coronal and sagittal planes, the lateral osteophyte difference, and the vertebral body index did not correlate with curve progression. Conclusions The findings of this study demonstrated that the progression of DLS was affected by the relationship between the intercrest line and the L-5 vertebra. When L-5 was deep seated, progression of DLS was found. Asymmetrical change in the disc space above and below the L-3 or apical vertebra may also be an important predictor of curve progression.

Practical answers to frequently asked questions for shared decision-making in adult spinal deformity surgery

2020 ◽  
pp. 1-10
Author(s):  
Yoji Ogura ◽  
Jeffrey L. Gum ◽  
Alex Soroceanu ◽  
Alan H. Daniels ◽  
Breton Line ◽  
...  
Keyword(s):  
Decision Making ◽  
Blood Transfusion ◽  
Shared Decision Making ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Activity Level ◽  
Shared Decision ◽  
Initial Surgery ◽  
The Mean

OBJECTIVEThe shared decision-making (SDM) process provides an opportunity to answer frequently asked questions (FAQs). The authors aimed to present a concise list of answers to FAQs to aid in SDM for adult spinal deformity (ASD) surgery.METHODSFrom a prospective, multicenter ASD database, patients enrolled between 2008 and 2016 who underwent fusions of 5 or more levels with a minimum 2-year follow-up were included. All deformity types were included to provide general applicability. The authors compiled a list of FAQs from patients undergoing ASD surgery and used a retrospective analysis to provide answers. All responses are reported as either the means or the proportions reaching the minimal clinically important difference at the 2-year follow-up interval.RESULTSOf 689 patients with ASD who were eligible for 2-year follow-up, 521 (76%) had health-related quality-of-life scores available at the time of that follow-up. The mean age at the initial surgery was 58.2 years, and 78% of patients were female. The majority (73%) underwent surgery with a posterior-only approach. The mean number of fused levels was 12.2. Revision surgery accounted for 48% of patients. The authors answered 12 FAQs as follows:1. Will my pain improve? Back and leg pain will both be reduced by approximately 50%.2. Will my activity level improve? Approximately 65% of patients feel improvement in their activity level.3. Will I feel better about myself? More than 70% of patients feel improvement in their appearance.4. Is there a chance I will get worse? 4.1% feel worse at 2 years postoperatively.5. What is the likelihood I will have a complication? 67.8% will have a major or minor complication, with 47.8% having a major complication.6. Will I need another surgery? 25.0% will have a reoperation within 2 years.7. Will I regret having surgery? 6.5% would not choose the same treatment.8. Will I get a blood transfusion? 73.7% require a blood transfusion.9. How long will I stay in the hospital? You need to stay 8.1 days on average.10. Will I have to go to the ICU? 76.0% will have to go to the ICU.11. Will I be able to return to work? More than 70% will be working at 1 year postoperatively.12. Will I be taller after surgery? You will be 1.1 cm taller on average.CONCLUSIONSThe above list provides concise, practical answers to FAQs encountered in the SDM process while counseling patients for ASD surgery.

Comparison of two minimally invasive surgery strategies to treat adult spinal deformity

2015 ◽  
Vol 22 (4) ◽  
pp. 374-380 ◽  
Author(s):  
Paul Park ◽  
Michael Y. Wang ◽  
Virginie Lafage ◽  
Stacie Nguyen ◽  
John Ziewacz ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Cobb Angle ◽  
Invasive Surgery ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Significant Difference ◽  
Vas Scores ◽  
The Mean

OBJECT Minimally invasive surgery (MIS) techniques are becoming a more common means of treating adult spinal deformity (ASD). The aim of this study was to compare the hybrid (HYB) surgical approach, involving minimally invasive lateral interbody fusion with open posterior instrumented fusion, to the circumferential MIS (cMIS) approach to treat ASD. METHODS The authors performed a retrospective, multicenter study utilizing data collected in 105 patients with ASD who were treated via MIS techniques. Criteria for inclusion were age older than 45 years, coronal Cobb angle greater than 20°, and a minimum of 1 year of follow-up. Patients were stratified into 2 groups: HYB (n = 62) and cMIS (n = 43). RESULTS The mean age was 60.7 years in the HYB group and 61.0 years in the cMIS group (p = 0.910). A mean of 3.6 interbody fusions were performed in the HYB group compared with a mean of 4.0 interbody fusions in the cMIS group (p = 0.086). Posterior fusion involved a mean of 6.9 levels in the HYB group and a mean of 5.1 levels in the cMIS group (p = 0.003). The mean follow-up was 31.3 months for the HYB group and 38.3 months for the cMIS group. The mean Oswestry Disability Index (ODI) score improved by 30.6 and 25.7, and the mean visual analog scale (VAS) scores for back/leg pain improved by 2.4/2.5 and 3.8/4.2 for the HYB and cMIS groups, respectively. There was no significant difference between groups with regard to ODI or VAS scores. For the HYB group, the lumbar coronal Cobb angle decreased by 13.5°, lumbar lordosis (LL) increased by 8.2°, sagittal vertical axis (SVA) decreased by 2.2 mm, and LL–pelvic incidence (LL-PI) mismatch decreased by 8.6°. For the cMIS group, the lumbar coronal Cobb angle decreased by 10.3°, LL improved by 3.0°, SVA increased by 2.1 mm, and LL-PI decreased by 2.2°. There were no significant differences in these radiographic parameters between groups. The complication rate, however, was higher in the HYB group (55%) than in the cMIS group (33%) (p = 0.024). CONCLUSIONS Both HYB and cMIS approaches resulted in clinical improvement, as evidenced by decreased ODI and VAS pain scores. While there was no significant difference in degree of radiographic correction between groups, the HYB group had greater absolute improvement in degree of lumbar coronal Cobb angle correction, increased LL, decreased SVA, and decreased LL-PI. The complication rate, however, was higher with the HYB approach than with the cMIS approach.

scholarly journals Surgical Outcomes of Multilevel Posterior Lumbar Interbody Fusion versus Lateral Lumbar Interbody Fusion for the Correction of Adult Spinal Deformity: A Comparative Clinical Study

2020 ◽  
Vol 14 (4) ◽  
pp. 421-429 ◽  
Author(s):  
Masayoshi Iwamae ◽  
Akira Matsumura ◽  
Takashi Namikawa ◽  
Minori Kato ◽  
Yusuke Hori ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Deformity ◽  
Surgical Outcomes ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Posterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion ◽  
The Mean

Study Design: A retrospective case control study.Purpose: The purpose of this study was to compare the surgical outcomes of multilevel lateral lumbar interbody fusion (LIF) and multilevel posterior lumbar interbody fusion (PLIF) in the surgical treatment of adult spinal deformity (ASD) and to evaluate the sagittal plane correction by combining LIF with posterior-column osteotomy (PCO).Overview of Literature: The surgical outcomes between multilevel LIF and multilevel PLIF in ASD patients remain unclear.Methods: We retrospectively reviewed 31 ASD patients who underwent multilevel LIF combined with PCO (LIF group, n=14) or multilevel PLIF (PLIF group, n=17) and with a minimum 2-year follow-up. In the comparison between LIF and PLIF groups, their mean age at surgery was 69.4 vs. 61.8 years while the mean follow-up period was 29.2 vs. 59.3 months. We evaluated the transition of pelvic incidence–lumbar lordosis (PI–LL) and disc angle (DA) in the LIF group, in fulcrum backward bending (FBB), after LIF and after posterior spinal fusion (PSF) with PCO. The spinopelvic radiographic parameters were compared between LIF and PLIF groups.Results: Compared with the PLIF group, the LIF group had less blood loss and comparable surgical outcomes with respect to radiographic data, health-related quality of life scores and surgical time. In the LIF group, the mean DA and PI–LL were unchanged after LIF (DA, 5.8°; PI–LL, 15°) compared with the values using FBB (DA, 4.3°; PI–LL, 15°) and improved significantly after PSF with PCO (DA, 8.1°; PI–LL, 0°).Conclusions: In the surgical treatment of ASD, multilevel LIF is less invasive than multilevel PLIF and combination of LIF and PCO would be necessary for optimal sagittal correction in patients with rigid deformity.

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