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

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.

Download Full-text

Minimally invasive anterior lumbar interbody fusion for adult degenerative scoliosis with 1 or 2 dislocated levels

Journal of Neurosurgery Spine ◽

10.3171/2015.3.spine14772 ◽

2015 ◽

Vol 23 (6) ◽

pp. 739-746 ◽

Cited By ~ 9

Author(s):

Charles-Henri Flouzat-Lachaniette ◽

Louis Ratte ◽

Alexandre Poignard ◽

Jean-Charles Auregan ◽

Steffen Queinnec ◽

...

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Anterior Lumbar Interbody Fusion ◽

Leg Pain ◽

Lumbar Interbody Fusion ◽

Degenerative Scoliosis ◽

Surgical Morbidity ◽

Adult Degenerative Scoliosis ◽

The Mean

OBJECT Frequent complications of posterolateral instrumented fusion have been reported after treatment of degenerative scoliosis in elderly patients. Considering that in some cases, most of the symptomatology of adult degenerative scoliosis (ADS) is a consequence of the segmental instability at the dislocated level, the use of minimally invasive anterior lumbar interbody fusion (ALIF) to manage symptoms can be advocated to reduce surgical morbidity. The purpose of this study was to evaluate the midterm outcomes of 1- or 2-level minimally invasive ALIFs in ADS patients with 1- or 2-level dislocations. METHODS A total of 47 patients (average age 64 years; range 43–80 years) with 1- or 2-level ALIF performed for ADS (64 levels) in a single institution were included in the study. An independent spine surgeon retrospectively reviewed all the patients’ medical records and radiographs to assess operative data and surgery-related complications. Clinical outcome was reported using the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for lumbar and leg pain. Intraoperative data and complications were collected. Fusion and risk for adjacent-level degeneration were assessed. RESULTS The mean follow-up duration was 3 years (range 1–10 years). ODI, and back and leg pain VAS scores were significantly improved at last follow-up. A majority of patients (74%) had a statistically significant improvement in their ODI score of more than 20 points at latest follow-up and 1 had a worsening of his disability. The mean operating time was 166 minutes (range 70–355 minutes). The mean estimated blood loss was 410 ml (range 50–1700 ml). Six (5 major and 1 minor) surgical complications (12.7% of patients) and 13 (2 major and 11 minor) medical complications (27.7% of patients) occurred without death or wound infection. Fusion was achieved in 46 of 47 patients. Surgery resulted in a slight but significant decrease of the Cobb angle, and improved the pelvic parameters and lumbar lordosis, but had no effect on the global sagittal balance. At latest follow-up, 9 patients (19.1%) developed adjacent-segment disease at a mean of 2 years’ delay from the index surgery; 4 were symptomatic but treated medically, and none required iterative surgery. CONCLUSIONS Single- or 2-level minimally invasive fusion through a minimally invasive anterior approach in some selected cases of ADS produced a good functional outcome with a high fusion rate. They were associated with a significantly lower rate of complications in this study than the historical control.

Download Full-text

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

10.21203/rs.2.12545/v1 ◽

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.

Download Full-text

Scoliosis Research Society-Schwab Grade 6 Osteotomy for Severe Congenital Angular Kyphoscoliosis: An Analysis of 17 Cases With a Minimum 2-Year Follow-up

Neurosurgery ◽

10.1093/neuros/nyaa055 ◽

2020 ◽

Vol 87 (5) ◽

pp. 925-930 ◽

Cited By ~ 1

Author(s):

Bo Shi ◽

Benlong Shi ◽

Dun Liu ◽

Yang Li ◽

Sanqiang Xia ◽

...

Keyword(s):

Cobb Angle ◽

Clinical Outcomes ◽

Vertical Axis ◽

Research Society ◽

Sagittal Vertical Axis ◽

Vertebral Column Resection ◽

Scoliosis Research Society ◽

Rod Breakage ◽

The Mean

Abstract BACKGROUND For some patients with severe congenital angular kyphoscoliosis (SCAK), 1-level vertebral column resection is insufficient and the Scoliosis Research Society (SRS)-Schwab Grade 6 osteotomy may be necessary. However, the indications and clinical outcomes of SRS-Schwab Grade 6 osteotomy in patients with SCAK have not been investigated in depth. OBJECTIVE To investigate the middle-term radiographic and clinical outcomes, and to evaluate the safety of this high technique-demanding procedure. METHODS Patients with SCAK undergoing SRS-Schwab Grade 6 osteotomy from 2005 to 2016 followed up at least 2 yr were retrospectively reviewed. The potential indications of SRS-Schwab Grade 6 osteotomy were analyzed. The coronal Cobb angle, segmental kyphosis (SK), deformity angular ratio (DAR), coronal balance, and sagittal vertical axis (SVA) were measured in the preoperative, postoperative, and final follow-up. The intraoperative and postoperative complications were recorded. RESULTS A total of 17 patients with SCAK (10 M and 7F) were included, and the mean follow-up was 30.8 ± 16.4 mo. The indications of SRS-Schwab Grade 6 osteotomy were as follows: multiple “pushed-out” hemivertebrae (13, 76.5%) and multilevel anterior block (4, 23.5%). Compared with preoperation, the coronal Cobb angle, SK and SVA at postoperation were significantly improved (P < .05 for all). The mean total DAR was 33.4 ± 9.9 at preoperation. Three patients were found to have postoperative neurological deficit. Rod breakage occurred in 3 patients at 15- to 48-mo follow-up, and revision surgeries were performed. At the last follow-up, firm bony fusion was observed in all patients. CONCLUSION The technique-demanding SRS-Schwab Grade 6 osteotomy, if well indicated, could provide satisfying correction of the SCAK deformity.

Download Full-text

Revision Strategies for Harrington Rod Instrumentation: Radiographic Outcomes and Complications

Global Spine Journal ◽

10.1177/2192568220960759 ◽

2020 ◽

pp. 219256822096075

Author(s):

Philip K. Louie ◽

Sravisht Iyer ◽

Krishn Khanna ◽

Garrett K. Harada ◽

Alina Khalid ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Revision Surgery ◽

Lumbar Lordosis ◽

Pelvic Incidence ◽

Vertical Axis ◽

Sagittal Vertical Axis ◽

Radiographic Outcomes ◽

Harrington Rod

Study Design: Retrospective case series. Objective: The purpose of this study is to evaluate the clinical and radiographic outcomes following revision surgery following Harrington rod instrumentation. Methods: Patients who underwent revision surgery with a minimum of 1-year follow-up for flatback syndrome following Harrington rod instrumentation for adolescent idiopathic scoliosis were identified from a multicenter dataset. Baseline demographics and intraoperative information were obtained. Preoperative, initial postoperative, and most recent spinopelvic parameters were compared. Postoperative complications and reoperations were subsequently evaluated. Results: A total of 41 patients met the inclusion criteria with an average follow-up of 27.7 months. Overall, 14 patients (34.1%) underwent a combined anterior-posterior fusion, and 27 (65.9%) underwent an osteotomy for correction. Preoperatively, the most common lower instrumented vertebra (LIV) was at L3 and L4 (61%), whereas 85% had a LIV to the pelvis after revision. The mean preoperative pelvic incidence–lumbar lordosis mismatch and C7 sagittal vertical axis were 23.7° and 89.6 mm. This was corrected to 8.1° and 28.9 mm and maintained to 9.04° and 34.4 mm at latest follow-up. Complications included deep wound infection (12.2%), durotomy (14.6%), implant related failures (14.6%), and temporary neurologic deficits (22.0%). Eight patients underwent further revision surgery at an average of 7.4 months after initial revision. Conclusions: There are multiple surgical techniques to address symptomatic flatback syndrome in patients with previous Harrington rod instrumentation for adolescent idiopathic scoliosis. At an average of 27.7 months follow-up, pelvic incidence–lumbar lordosis mismatch and C7 sagittal vertical axis can be successfully corrected and maintained. However, complication and reoperation rates remain high.

Download Full-text

The Effect of Lumbar Lordosis on Screw Loosening in Dynesys Dynamic Stabilization: Four-Year Follow-Up with Computed Tomography

BioMed Research International ◽

10.1155/2015/152435 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Chao-Hung Kuo ◽

Peng-Yuan Chang ◽

Tsung-Hsi Tu ◽

Li-Yu Fay ◽

Hsuan-Kan Chang ◽

...

Keyword(s):

Computed Tomography ◽

Clinical Outcomes ◽

Lumbar Lordosis ◽

Degenerative Spondylolisthesis ◽

Dynamic Stabilization ◽

Leg Pain ◽

Screw Loosening ◽

Disc Disease ◽

Radiographic Outcomes

Introduction. This study aimed to evaluate the effects of Dynesys dynamic stabilization (DDS) on clinical and radiographic outcomes, including spinal pelvic alignment.Method. Consecutive patients who underwent 1- or 2-level DDS for lumbar spondylosis, mild degenerative spondylolisthesis, or degenerative disc disease were included. Clinical outcomes were evaluated by Visual Analogue Scale for back and leg pain, Oswestry Disability Index, and the Japanese Orthopedic Association scores. Radiographic outcomes were assessed by radiographs and computed tomography. Pelvic incidence and lumbar lordosis (LL) were also compared.Results. In 206 patients with an average follow-up of 51.1 ± 20.8 months, there were 87 screws (8.2%) in 42 patients (20.4%) that were loose. All clinical outcomes improved at each time point after operation. Patients with loosened screws were 45 years older. Furthermore, there was a higher risk of screw loosening in DDS involving S1, and these patients were more likely to have loosened screws if the LL failed to increase after the operation.Conclusions. The DDS screw loosening rate was overall 8.2% per screw and 20.4% per patient at more than 4 years of follow-up. Older patients, S1 involvement, and those patients who failed to gain LL postoperatively were at higher risk of screw loosening.

Download Full-text

Minimally invasive lateral approach for adult degenerative scoliosis: lessons learned

Neurosurgical FOCUS ◽

10.3171/2013.5.focus13173 ◽

2013 ◽

Vol 35 (2) ◽

pp. E4 ◽

Cited By ~ 34

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.

Download Full-text

CAN PATIENTS WITH SAGITTALLY WELL-COMPENSATED LUMBAR DEGENERATIVE KYPHOSIS BENEFIT FROM SURGICAL TREATMENT FOR INTRACTABLE BACK PAIN?

Neurosurgery ◽

10.1227/01.neu.0000335642.14527.26 ◽

2009 ◽

Vol 64 (1) ◽

pp. 115-121 ◽

Cited By ~ 28

Author(s):

Jee-Soo Jang ◽

Sang-Ho Lee ◽

Jung Mok Kim ◽

Jun-Hong Min ◽

Kyung-Mi Han ◽

...

Keyword(s):

Back Pain ◽

Oswestry Disability Index ◽

Lumbar Lordosis ◽

Rating Scale ◽

Numeric Rating Scale ◽

Leg Pain ◽

Compensatory Mechanisms ◽

The Mean ◽

Numeric Rating

Abstract OBJECTIVE To analyze pre- and postoperative x-rays of sagittal spines and to review the surgical results of 21 patients with lumbar degenerative kyphosis whose spines were sagittally well compensated by compensatory mechanisms but who continued to suffer from intractable back pain METHODS We performed a retrospective review of 21 patients treated with combined anterior and posterior spinal arthrodesis. Inclusion criteria were: lumbar degenerative kyphosis patients with intractable back pain and whose spines were sagittally well compensated by a compensatory mechanism, defined as a C7 plumb line to the posterior aspect of the L5–S1 disc of less than 5 cm. Outcome variables included: radiographic measures of preoperative, postoperative, and follow-up films; clinical assessment using the mean Numeric Rating Scale, Oswestry Disability Index, and Patient Satisfaction Index; and a review of postoperative complications. RESULTS All patients were female (mean age, 64.5 years; age range, 50–74 years). The mean preoperative sagittal imbalance was 19.5 (± 17.6) mm, which improved to −15.8 (± 22.2) mm after surgery. Mean lumbar lordosis was 13.2 degrees (± 15.3) before surgery and increased to 38.1 degrees (± 14.4) at follow-up (P < 0.0001). Mean thoracic kyphosis was 5.5 degrees (± 10.2) before surgery and increased to 18.9 degrees (± 12.4) at follow-up (P < 0.0001). Mean sacral slopes were 12.9 degrees (± 11.1) before surgery and increased to 26.3 degrees (± 9.6) at follow-up (P < 0.0001). The mean Numeric Rating Scale score improved from 7.8 (back pain) and 8.1 (leg pain) before surgery to 3.0 (back pain) and 2.6 (leg pain) after surgery (P < 0.0001). The mean Oswestry Disability Index scores improved from 56.2% before surgery to 36.7% after surgery (P < 0.0001). In 18 (85.5%) of 21 patients, satisfactory outcomes were demonstrated by the time of the last follow-up assessment. CONCLUSION This study shows that even lumbar degenerative kyphosis patients with spines that are sagittally well compensated by compensatory mechanisms may suffer from intractable back pain and that these patients can be treated effectively by the restoration of lumbar lordosis.

Download Full-text

Short-term effectiveness of precise safety decompression via double percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral lumbar spinal canal stenosis: a prospective cohort study

10.21203/rs.3.rs-20818/v3 ◽

2020 ◽

Author(s):

Yu Wang ◽

Mingyan Deng ◽

Hao Wu ◽

Ye Wu ◽

Chuan Guo ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Prospective Cohort ◽

Spinal Canal ◽

Leg Pain ◽

Short Term ◽

Postoperative Mri ◽

The Mean ◽

Lumbar Spinal

Abstract Purpose This prospective cohort study reports on a new technique, namely precise safety decompression via double percutaneous lumbar foraminoplasty (DPLF) and percutaneous endoscopic lumbar decompression (PELD) for lateral lumbar spinal canal (LLSC) stenosis, and its short-term clinical outcomes.Methods The study analyzed 69 patients with single-level LLSC stenosis simultaneously occurring in both zones 1 and 2 (defined as retrodiscal space and upper bony lateral recess respectively by new LLSC classification) who underwent DPLF–PELD from November 2018 to April 2019. Clinical outcomes were evaluated according to preoperative, three months postoperatively, and last follow-up, via leg pain/low back pain (LBP) visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, and the Macnab criteria. The postoperative MRI and CT were used to confirm the complete decompression, and flexion-extension x-rays at the last follow-up were used to observe lumbar stability.Results All patients successfully underwent DPLF–PELD, and the stenosis was completely decompressed, confirmed by postoperative MRI and CT. The mean follow-up duration was 13 months (range: 8–17 months). The mean preoperative leg pain VAS score is 7.05 ± 1.04 (range 5–9), which decreased to 1.03 ± 0.79(range: 0–3) at three months postoperatively and to 0.75 ± 0.63 (range: 0–2) by the last follow-up visit(p < 0.05). The mean preoperative ODI was 69.8 ± 9.05 (range: 52–85), which decreased to 20.3 ± 5.52 (range: 10–35) at the third month postoperatively and to 19.6 ± 5.21 (range: 10–34) by the final follow-up visit(p < 0.05). The satisfactory (excellent or good) results were 94.2%. There was one patient with aggravated symptoms, which were relieved after an open surgery. Two patients had a dural tear, and two patients suffered postoperative LBP. No recurrence or segmental instability was observed at the final follow-up.Conclusion DPLF–PELD could be a good alternative for the treatment of LLSC stenosis patients whose stenosis occurred in both zones 1 and 2.Trial registration Chinese Clinical Trial Registry (ChiCTR1800019551). Registered 18 November 2018.

Download Full-text

Posterior column osteotomy plus unilateral cage strutting for correction of lumbosacral fractional curve in degenerative lumbar scoliosis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02011-y ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Hui Wang ◽

Longjie Wang ◽

Zhuoran Sun ◽

Shuai Jiang ◽

Weishi Li

Keyword(s):

Lumbar Lordosis ◽

Vertical Axis ◽

Posterior Column ◽

Degenerative Lumbar Scoliosis ◽

Sagittal Vertical Axis ◽

Lumbar Scoliosis ◽

Coronal Balance ◽

Bone Fusion ◽

Cage Subsidence

Abstract Background Inadequate release of the posterior spinal bone elements may hinder the correction of the lumbosacral fractional curve in degenerative lumbar scoliosis, since the lumbosacral junction tends to be particularly rigid and may already be fused into an abnormal position. The purpose of this study was to evaluate the surgical outcome and complications of posterior column osteotomy plus unilateral cage strutting technique on lumbosacral concavity for correction of fractional curve in degenerative lumbar scoliosis patients. Methods Thirty-two degenerative lumbar scoliosis patients with lumbosacral fractional curve more than 15° that were surgically treated by posterior column osteotomy plus unilateral cage strutting technique were retrospectively reviewed. The patients’ medical records were reviewed to identify demographic and surgical data, including age, sex, body mass index, back pain, leg pain, Oswestry Disability Index, operation time, blood loss, and instrumentation levels. Radiological data including coronal balance distance, Cobb angle, lumbosacral coronal angle, sagittal vertical axis, lumbar lordosis, and lumbosacral lordotic angle were evaluated before and after surgery. Cage subsidence and bone fusion were evaluated at 2-year follow-up. Results All patients underwent the operation successfully; lumbosacral coronal angle changed from preoperative 20.1 ± 5.3° to postoperative 5.8 ± 5.7°, with mean correction of 14.3 ± 4.4°, and the correction was maintained at 2-year follow-up. Cobb’s angle and coronal balance distance decreased from preoperative to postoperative; the correction was maintained at 2-year follow-up. Sagittal vertical axis decreased, and lumbar lordosis increased from preoperative to postoperative; the correction was also maintained at 2-year follow-up. Lumbosacral lordotic angle presented no change from preoperative to postoperative and from postoperative to 2-year follow-up. Postoperatively, there were 8 patients with lumbosacral coronal angle more than 10°, they got the similar lumbosacral coronal angle correction, but presented larger preoperative Cobb and lumbosacral coronal angle than the other 24 patients. No cage subsidence was detected; all patients achieved intervertebral bone fusion and inter-transverse bone graft fusion at the lumbosacral region at 2-year follow-up. Conclusion Posterior column osteotomy plus unilateral cage strutting technique on the lumbosacral concavity facilitate effective correction of the fractional curve in degenerative lumbar scoliosis patients through complete release of dural sac as well as the asymmetrical intervertebral reconstruction by cage.

Download Full-text

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

Journal of Neurosurgery Spine ◽

10.3171/2016.10.spine16535 ◽

2017 ◽

Vol 26 (5) ◽

pp. 638-644 ◽

Cited By ~ 5

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.

Download Full-text