scholarly journals Minimally invasive lateral approach for adult degenerative scoliosis: lessons learned

2013 ◽  
Vol 35 (2) ◽  
pp. E4 ◽  
Author(s):  
Armen R. Deukmedjian ◽  
Amir Ahmadian ◽  
Konrad Bach ◽  
Alexandros Zouzias ◽  
Juan S. Uribe
Keyword(s):  
Minimally Invasive ◽  
Cobb Angle ◽  
Clinical Outcomes ◽  
Lumbar Lordosis ◽  
Traditional Approach ◽  
Lateral Approach ◽  
Lessons Learned ◽  
Degenerative Scoliosis ◽  
Adult Degenerative Scoliosis ◽  
Scoliosis Correction

Object Lateral minimally invasive thoracolumbar instrumentation techniques are playing an increasing role in the treatment of adult degenerative scoliosis. However, there is a paucity of data in determining the ideal candidate for a lateral versus a traditional approach, and versus a hybrid construct. The objective of this study is to present a method for utilizing the lateral minimally invasive surgery (MIS) approach for adult spinal deformity, provide clinical outcomes to validate our experience, and determine the limitations of lateral MIS for adult degenerative scoliosis correction. Methods Radiographic and clinical data were collected for patients who underwent surgical correction of adult degenerative scoliosis between 2007 and 2012. Patients were retrospectively classified by degree of deformity based on coronal Cobb angle, central sacral vertical line (CSVL), pelvic incidence, lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), presence of comorbidities, bone quality, and curve flexibility. Patients were placed into 1 of 3 groups according to the severity of deformity: “green” (mild), “yellow” (moderate), and “red” (severe). Clinical outcomes were determined by a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Results Of 256 patients with adult degenerative scoliosis, 174 underwent a variant of the lateral approach. Of these 174 patients, 27 fit the strict inclusion/exclusion criteria (n = 9 in each of the 3 groups). Surgery in 17 patients was dictated by their category, and 10 were treated with surgery outside of their classification. The average age was 61 years old and the mean follow-up duration was 17 months. The green and yellow groups experienced a reduction in coronal Cobb angle (12° and 11°, respectively), and slight changes in CSVL, SVA, and PT, and LL. In the green group, the VAS and ODI improved by 35 and 17 points, respectively, while in the yellow group they improved by 36 and 33 points, respectively. The red subgroup showed a 22° decrease in coronal Cobb angle, 15° increase in LL, and slight changes in PT and SVA. Three patients placed in the yellow subgroup had “green” surgery, and experienced a coronal Cobb angle and LL decrease by 17° and 10°, respectively, and an SVA and PT increase by 1.3 cm and 5°, respectively. Seven patients placed in the red group who underwent “yellow” or “green” surgery had a reduction in coronal Cobb angle of 16°, CSVL of 0.1 cm, SVA of 2.8 cm, PT of 4°, VAS of 28 points, and ODI of 12 points; lumbar lordosis increased by 15°. Perioperative complications included 1 wound infection, transient postoperative thigh numbness in 2 cases, and transient groin pain in 1 patient. Conclusions Careful patient selection is important for the application of lateral minimally invasive techniques for adult degenerative scoliosis. Isolated lateral interbody fusion with or without instrumentation is suitable for patients with preserved spinopelvic harmony. Moderate sagittal deformity (compensated with pelvic retroversion) may be addressed with advanced derivatives of the lateral approach, such as releasing the anterior longitudinal ligament. For patients with severe deformity, the lateral approach may be used for anterior column support and to augment arthrodesis.

scholarly journals Limitations and ceiling effects with circumferential minimally invasive correction techniques for adult scoliosis: analysis of radiological outcomes over a 7-year experience

2014 ◽  
Vol 36 (5) ◽  
pp. E14 ◽  
Author(s):  
Neel Anand ◽  
Eli M. Baron ◽  
Babak Khandehroo
Keyword(s):  
Minimally Invasive ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Sagittal Plane ◽  
Adult Scoliosis ◽  
Angle Correction ◽  
Scoliosis Correction ◽  
Spinopelvic Parameter ◽  
Ceiling Effects ◽  
The Mean

Object Minimally invasive correction of adult scoliosis is a surgical method increasing in popularity. Limited data exist, however, as to how effective these methodologies are in achieving coronal plane and sagittal plane correction in addition to improving spinopelvic parameters. This study serves to quantify how much correction is possible with present circumferential minimally invasive surgical (cMIS) methods. Methods Ninety patients were selected from a database of 187 patients who underwent cMIS scoliosis correction. All patients had a Cobb angle greater than 15°, 3 or more levels fused, and availability of preoperative and postoperative 36-inch standing radiographs. The mean duration of follow-up was 37 months. Preoperative and postoperative Cobb angle, sagittal vertical axis (SVA), coronal balance, lumbar lordosis (LL), and pelvic incidence (PI) were measured. Scatter plots were performed comparing the pre- and postoperative radiological parameters to calculate ceiling effects for SVA correction, Cobb angle correction, and PI-LL mismatch correction. Results The mean preoperative SVA value was 60 mm (range 11.5–151 mm); the mean postoperative value was 31 mm (range 0–84 mm). The maximum SVA correction achieved with cMIS techniques in any of the cases was 89 mm. In terms of coronal Cobb angle, a mean correction of 61% was noted, with a mean preoperative value of 35.8° (range 15°–74.7°) and a mean postoperative value of 13.9° (range 0°–32.5°). A ceiling effect for Cobb angle correction was noted at 42°. The ability to correct the PI-LL mismatch to 10° was limited to cases in which the preoperative PI-LL mismatch was 38° or less. Conclusions Circumferential MIS techniques as currently used for the treatment of adult scoliosis have limitations in terms of their ability to achieve SVA correction and lumbar lordosis. When the preoperative SVA is greater than 100 mm and a substantial amount of lumbar lordosis is needed, as determined by spinopelvic parameter calculations, surgeons should consider osteotomies or other techniques that may achieve more lordosis.

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

2014 ◽  
Vol 36 (5) ◽  
pp. E11 ◽  
Author(s):  
Zachary J. Tempel ◽  
Gurpreet S. Gandhoke ◽  
Christopher M. Bonfield ◽  
David O. Okonkwo ◽  
Adam S. Kanter
Keyword(s):  
Clinical Outcomes ◽  
Lumbar Lordosis ◽  
Hybrid Approach ◽  
Vertical Axis ◽  
Leg Pain ◽  
Degenerative Scoliosis ◽  
Sagittal Vertical Axis ◽  
Adult Degenerative Scoliosis ◽  
The Mean

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.

scholarly journals Clinical Outcomes after Minimally Invasive Trans-Psoas Lateral Lumbar Interbody Fusion for the Treatment of Adult Degenerative Scoliosis: Four Years’ Multicenter Study

2020 ◽  
Vol 9 (03) ◽  
pp. 225-229
Author(s):  
Sheikh Asad ◽  
Arjun Dubey ◽  
Arvind Dubey ◽  
Chester Sutterlin
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbar Interbody Fusion ◽  
Degenerative Scoliosis ◽  
Lumbar Scoliosis ◽  
Adult Degenerative Scoliosis ◽  
Outcome Scores

AbstractThe use of minimally invasive transpsoas lateral lumbar interbody fusion (LLIF) surgery for treatment of adult degenerative scoliosis is rapidly increasing in popularity. However, limited data is available regarding its use in adult degenerative lumbar scoliosis surgery. The objective of this study was to evaluate the clinical outcomes of adults with degenerative lumbar scoliosis who were treated with minimally invasive LLIF. Thirty-two consecutive patients with adult degenerative scoliosis treated by a single surgeon at two spine centers were followed up for an average of 13.2 months. Interbody fusion was completed using the minimally invasive LLIF technique with supplemental 360 degrees’ posterior instrumentation. Oswestry disability index (ODI) scores were obtained preoperatively and at most recent follow-up. Complications were recorded. The study group demonstrated improvement in clinical outcome scores. ODI scores improved from 36.8 to 23.4 (p < 0.00001). A total of four complications (12%) were recorded, and two patients (6%) required additional surgery. Based on the significant improvement in validated clinical outcome scores, minimally invasive LLIF can be considered an effective procedure in the treatment of adult degenerative scoliosis.

scholarly journals The clinical and radiographic outcomes of stand-alone Oblique Lateral Interbody Fusion in Treatment of Adult Degenerative Scoliosis

2019 ◽  
Author(s):  
Chen Liu ◽  
Xin Ge ◽  
Yu Zhang ◽  
Liang Xiao ◽  
Hongguang Xu
Keyword(s):  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Degenerative Scoliosis ◽  
Adult Degenerative Scoliosis ◽  
Radiographic Outcomes ◽  
The Mean ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Abstract Background The minimally invasive treatment for adult degenerative scoliosis has become more and more popular. The purpose of this study was to evaluate the efficiency of stand-alone oblique lateral interbody fusion for the treatment of adult degenerative scoliosis in terms of clinical and radiological outcomes. Methods A total of 18 patients with ADS who underwent stand-alone OLIF in our hospital from July 2017 to May 2018 were enrolled in the study. Clinical evaluations were performed with visual analogue scale (VAS) and Oswestry Disability Index (ODI). Radiographic outcomes were recorded in terms of coronal Cobb angle and lumbar lordosis. Results Mean patient age was 62.4 years, 50% of patients were female. Average follow up was 18.4 months. The average operative duration was 87.4 minutes, whilst the mean estimated blood loss was 45.6 ml. Mean coronal Cobb angle corrected from preoperative 15.2° to the final follow-up 6.8° (p < 0.05); and mean lumbar lordosis improved from preoperative 30.0° to 39.4° (p < 0.05). Mean disc height increased from preoperative 0.7 cm to 1.1 cm at final follow-up (p < 0.05). Mean VAS improved from 5.5 to 2.2 (p < 0.05). The mean preoperative and the final follow-up Oswestry Disability Indices were 27.8% and 13.1% respectively (p < 0.05). Conclusions Stand-alone OLIF could be regarded as an efficient and safe option in the treatment of ADS for careful selected patients.

scholarly journals Therapeutic Strategy of Percutaneous Transforaminal Endoscopic Decompression for Stenosis Associated With Adult Degenerative Scoliosis

2020 ◽  
pp. 219256822095903
Author(s):  
Lin-Yu Jin ◽  
Kun Wang ◽  
Zhen-Dong Lv ◽  
Xin-Jin Su ◽  
Hai-Ying Liu ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cobb Angle ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Analysis ◽  
Lumbar Stenosis ◽  
Degenerative Scoliosis ◽  
Adult Degenerative Scoliosis ◽  
Lateral Subluxation ◽  
The Mean ◽  
Transforaminal Endoscopic Surgery

Study Design: A retrospective study. Objective: To investigate the effects of percutaneous transforaminal endoscopic decompression (PTED) for lumbar stenosis associated with adult degenerative scoliosis and to analyze the correlation between preoperative radiological parameters and postoperative surgical outcomes. Methods: Two years of retrospective data was collected from 46 patients with lumbar stenosis associated with adult degenerative scoliosis who underwent PTED. The visual analog scale (VAS), Oswestry Disability Index, and modified MacNab criteria were used to evaluate the clinical outcomes. Multiple linear regression analysis was used to analyze the correlation between radiological parameters and surgical outcomes. Results: The mean age of the 33 female and 13 male patients was 73.5 ± 8.1 years. The mean follow-up was 27.6 ± 3.5 months (range from 24 to 36). The average coronal Cobb angle was 24.5 ± 8.2°. There were better outcomes of the VAS for leg pain and Oswestry Disability Index after surgery. Based on the MacNab criteria, excellent or good outcomes were noted in 84.78% of patients. Multiple linear regression analysis showed that Cobb angle and lateral olisthy may be the predictors for low back pain. Conclusion: Transforaminal endoscopic surgery may be an effective and safe method for geriatric patients with lumbar stenosis associated with degenerative scoliosis. The predictive factors of clinical outcomes were severe Cobb angle and high degree lateral subluxation. Transforaminal endoscopic surgery may not be recommended for patients with Cobb angle larger than 30° combined with lateral subluxation.

scholarly journals Clinical Outcomes of Extreme Lateral Interbody Fusion in the Treatment of Adult Degenerative Scoliosis

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Adam M. Caputo ◽  
Keith W. Michael ◽  
Todd M. Chapman ◽  
Gene M. Massey ◽  
Cameron R. Howes ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Degenerative Lumbar Scoliosis ◽  
Degenerative Scoliosis ◽  
Lateral Interbody Fusion ◽  
Adult Degenerative Scoliosis ◽  
Outcome Scores ◽  
Extreme Lateral Interbody Fusion ◽  
Lateral Interbody

Introduction. The use of extreme lateral interbody fusion (XLIF) and other lateral access surgery is rapidly increasing in popularity. However, limited data is available regarding its use in scoliosis surgery. The objective of this study was to evaluate the clinical outcomes of adults with degenerative lumbar scoliosis treated with XLIF.Methods. Thirty consecutive patients with adult degenerative scoliosis treated by a single surgeon at a major academic institution were followed for an average of 14.3 months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Validated clinical outcome scores were obtained on patients preoperatively and at most recent follow-up. Complications were recorded.Results. The study group demonstrated improvement in multiple clinical outcome scores. Oswestry Disability Index scores improved from 24.8 to 19.0 (P < 0.001). Short Form-12 scores improved, although the change was not significant. Visual analog scores for back pain decreased from 6.8 to 4.6 (P < 0.001) while scores for leg pain decreased from 5.4 to 2.8 (P < 0.001). A total of six minor complications (20%) were recorded, and two patients (6.7%) required additional surgery.Conclusions. Based on the significant improvement in validated clinical outcome scores, XLIF is effective in the treatment of adult degenerative scoliosis.

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