Choi, Seung Won
(Department of Neurosurgery, Chungnam National University Hospital)
,
Ames, Christopher
(Department of Neurosurgery, University of California San Francisco)
,
Berven, Sigurd
(Department of Orthopaedic Surgery, University of California San Francisco)
,
Chou, Dean
(Department of Neurosurgery, University of California San Francisco)
,
Tay, Bobby
(Department of Orthopaedic Surgery, University of California San Francisco)
,
Deviren, Vedat
(Department of Orthopaedic Surgery, University of California San Francisco)
Objective : Lateral interbody fusion (LIF) is attractive as a less invasive technique to address anterior spinal pathology in the treatment of adult spinal deformity. Its own uses and benefits in treatment of adult degenerative scoliosis are undefined. To investigate the radiographic and clinical ou...
Objective : Lateral interbody fusion (LIF) is attractive as a less invasive technique to address anterior spinal pathology in the treatment of adult spinal deformity. Its own uses and benefits in treatment of adult degenerative scoliosis are undefined. To investigate the radiographic and clinical outcomes of LIF, and staged LIF and posterior spinal fusion (PSF) for the treatment of adult degenerative scoliosis patients, we analyzed radiographic and clinical outcomes of adult degenerative scoliosis patients who underwent LIF and posterior spinal fusion. Methods : Forty consecutive adult degenerative scoliosis patients who underwent LIF followed by staged PSF at a single institution were retrospectively reviewed. Long-standing 36" anterior-posterior and lateral radiographs were taken preoperatively, at inter-stage, 3 months, 1 year, and 2 years after surgery were reviewed. Outcomes were assessed through the visual analogue scale (VAS), 36-Item Short Form Health Survey (SF-36), and Oswestry Disability Index (ODI). Results : Forty patients with a mean age of 66.3 (range, 49-79) met inclusion criteria. A mean of 3.8 levels (range, 2-5) were fused using LIF, while a mean of 9.0 levels (range, 3-16) were fused during the posterior approach. The mean time between stages was 1.4 days (range, 1-6). The mean follow-up was 19.6 months. Lumbar lordosis was significantly restored from $36.4^{\circ}$ preoperatively up to $48.9^{\circ}$ (71.4% of total correction) after LIF and $53.9^{\circ}$ after PSF. Lumbar coronal Cobb was prominently improved from $38.6^{\circ}$ preoperatively to $24.1^{\circ}$ (55.8% of total correction) after LIF, $12.6^{\circ}$ after PSF respectively. The mean pelvic incidence-lumbar lordosis mismatch was markedly improved from $22.2^{\circ}$ preoperatively to $8.1^{\circ}$ (86.5% of total correction) after LIF, $5.9^{\circ}$ after PSF. Correction of coronal imbalance and sagittal vertebral axis did not reach significance. The rate of perioperative complication was 37.5%. Five patients underwent revision surgery due to wound infection. No major perioperative medical complications occurred. At last follow-up, there were significant improvements in VAS, SF-36 Physical Component Summary and ODI scores. Conclusion : LIF provides significant corrections in the coronal and sagittal plane in the patients with adult degenerative scoliosis. However, LIF combined with staged PSF provides more excellent radiographic and clinical outcomes, with reduced perioperative risk in the treatment of adult degenerative scoliosis.
Objective : Lateral interbody fusion (LIF) is attractive as a less invasive technique to address anterior spinal pathology in the treatment of adult spinal deformity. Its own uses and benefits in treatment of adult degenerative scoliosis are undefined. To investigate the radiographic and clinical outcomes of LIF, and staged LIF and posterior spinal fusion (PSF) for the treatment of adult degenerative scoliosis patients, we analyzed radiographic and clinical outcomes of adult degenerative scoliosis patients who underwent LIF and posterior spinal fusion. Methods : Forty consecutive adult degenerative scoliosis patients who underwent LIF followed by staged PSF at a single institution were retrospectively reviewed. Long-standing 36" anterior-posterior and lateral radiographs were taken preoperatively, at inter-stage, 3 months, 1 year, and 2 years after surgery were reviewed. Outcomes were assessed through the visual analogue scale (VAS), 36-Item Short Form Health Survey (SF-36), and Oswestry Disability Index (ODI). Results : Forty patients with a mean age of 66.3 (range, 49-79) met inclusion criteria. A mean of 3.8 levels (range, 2-5) were fused using LIF, while a mean of 9.0 levels (range, 3-16) were fused during the posterior approach. The mean time between stages was 1.4 days (range, 1-6). The mean follow-up was 19.6 months. Lumbar lordosis was significantly restored from $36.4^{\circ}$ preoperatively up to $48.9^{\circ}$ (71.4% of total correction) after LIF and $53.9^{\circ}$ after PSF. Lumbar coronal Cobb was prominently improved from $38.6^{\circ}$ preoperatively to $24.1^{\circ}$ (55.8% of total correction) after LIF, $12.6^{\circ}$ after PSF respectively. The mean pelvic incidence-lumbar lordosis mismatch was markedly improved from $22.2^{\circ}$ preoperatively to $8.1^{\circ}$ (86.5% of total correction) after LIF, $5.9^{\circ}$ after PSF. Correction of coronal imbalance and sagittal vertebral axis did not reach significance. The rate of perioperative complication was 37.5%. Five patients underwent revision surgery due to wound infection. No major perioperative medical complications occurred. At last follow-up, there were significant improvements in VAS, SF-36 Physical Component Summary and ODI scores. Conclusion : LIF provides significant corrections in the coronal and sagittal plane in the patients with adult degenerative scoliosis. However, LIF combined with staged PSF provides more excellent radiographic and clinical outcomes, with reduced perioperative risk in the treatment of adult degenerative scoliosis.
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문제 정의
The first aim of this study was to assess the magnitude of radiographic changes following staged LIF and PSF. For this task, we reviewed radiographs preoperatively, following LIF and before PSF (inter-stage), after PSF and at the most recent clinical follow up.
제안 방법
For the patients who were not able to undergo LIF at L5–S1 due to the iliac crest, but required additional fusion at L5–S1, anterior lumbar interbody fusion (ALIF) or transforaminal interbody fusion (TLIF) was performed.
Standing long cassette 36” anterior-posterior and lateral radiographs taken preoperatively, at inter-stage, 3 months, 1 year, and 2 years after surgery were reviewed.
The first aim of this study was to assess the magnitude of radiographic changes following staged LIF and PSF. For this task, we reviewed radiographs preoperatively, following LIF and before PSF (inter-stage), after PSF and at the most recent clinical follow up. We analyzed the degree of radiographic change between these time periods in order to determine each procedures contribution to the final surgical correction.
For this task, we reviewed radiographs preoperatively, following LIF and before PSF (inter-stage), after PSF and at the most recent clinical follow up. We analyzed the degree of radiographic change between these time periods in order to determine each procedures contribution to the final surgical correction. A second aim of this study was to analyze the functional outcomes, perioperative and postoperative complications of patients undergoing staged LIF and PSF procedures.
We analyzed the degree of radiographic change between these time periods in order to determine each procedures contribution to the final surgical correction. A second aim of this study was to analyze the functional outcomes, perioperative and postoperative complications of patients undergoing staged LIF and PSF procedures.
Posterior decompressive laminectomies, Smith-Petersen osteotomies, placement of pedicle screws, laminar hooks and iliac screws were performed. Fluoroscopy or an intra-operative computed tomography scan was used for confirmation of adequate placement of instrumentation before completion of the operation.
Posterior decompressive laminectomies, Smith-Petersen osteotomies, placement of pedicle screws, laminar hooks and iliac screws were performed. Fluoroscopy or an intra-operative computed tomography scan was used for confirmation of adequate placement of instrumentation before completion of the operation. For the patients who were not able to undergo LIF at L5–S1 due to the iliac crest, but required additional fusion at L5–S1, anterior lumbar interbody fusion (ALIF) or transforaminal interbody fusion (TLIF) was performed.
Functional outcomes were assessed by evaluating visual analogue scale (VAS) for back pain and leg pain, Oswestry Disability Index (ODI), 36-Item Short Form Health Survey mental component summary (SF-36 MCS), and 36-Item Short Form Health Survey physical component summary (SF-36 PCS) preoperatively, and at 3, 12, and 24 months after surgery. Perioperative and postoperative complications were also investigated.
23) reported 35% correction of coronal Cobb angle in adult degenerative scoliosis treated with XLIF. In this study, coronal Cobb angles were significantly restored in both the thoracic and lumbar region after staged correction.
The first stage was followed by an inter-stage of between 1–6 days, wherein the patient underwent standing long cassette 36” anterior-posterior and lateral radiographs, and were adequately resuscitated for the second procedure.
대상 데이터
Consecutive patients with adult degenerative scoliosis who underwent staged correction using LIF and PSF at a tertiary care spine referral center between 2008 and 2013 were enrolled. The diagnosis of adult degenerative scoliosis included at least one of the following : coronal Cobb angle greater than 20 degrees, sagittal imbalance greater than 5 cm, coronal imbalance greater than 5 cm, thoracic kyphosis greater than 60 degrees, thoracolumbar kyphosis greater than 20 degrees, or lumbar lordosis less than 20 degrees.
Radiographic measurements of preoperative, inter-stage, postoperative and last clinical follow up including long-standing 36” films were adequately obtained in 34 patients (85%) (Fig. 1).
데이터처리
Radiographic parameters and functional outcome variables were compared with their corresponding values using a paired t test. All statistical tests were two-sided and p-values less than 0.
성능/효과
This study demonstrates that LIF significantly contributed the correction of LL, lumbar coronal Cobb angle and PI–LL mismatch.
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