Clinical outcomes of extreme lateral interbody fusion in the treatment of adult degenerative scoliosis

Adam M Caputo, Keith W Michael, Todd M Chapman Jr, Gene M Massey, Cameron R Howes, Robert E Isaacs, Christopher R Brown, Adam M Caputo, Keith W Michael, Todd M Chapman Jr, Gene M Massey, Cameron R Howes, Robert E Isaacs, Christopher R Brown

Abstract

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.

Figures

Figure 1
Figure 1
Preoperative (a) and postoperative (b) anteroposterior radiographs of the lumbar spine in a patient treated with XLIF with percutaneous pedicle screws and rods.

References

    1. Vanderpool DW, James JI, Wynne-Davies R. Scoliosis in the elderly. The Journal of Bone and Joint Surgery. 1969;51(3):446–455.
    1. Tribus CB. Degenerative lumbar scoliosis: evaluation and management. The Journal of the American Academy of Orthopaedic Surgeons. 2003;11(3):174–183.
    1. Abumi K, Panjabi MM, Kramer KM, Duranceau J, Oxland T, Crisco JJ. Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine. 1990;15(11):1142–1147.
    1. Aebi M. The adult scoliosis. European Spine Journal. 2005;14(10):925–948.
    1. Daffner SD, Vaccaro AR. Adult degenerative lumbar scoliosis. The American Journal of Orthopedics. 2003;32(2):77–82.
    1. Birknes JK, White AP, Albert TJ, Shaffrey CI, Harrop JS. Adult degenerative scoliosis: a review. Neurosurgery. 2008;63(3):A94–A103.
    1. Bradford DS, Tay BKB, Hu SS. Adult scoliosis: surgical indications, operative management, complications, and outcomes. Spine. 1999;24(24):2617–2629.
    1. Gelalis ID, Kang JD. Thoracic and lumbar fusions for degenerative disorders: rationale for selecting the appropriate fusion techniques. Orthopedic Clinics of North America. 1998;29(4):829–842.
    1. Gupta MC. Degenerative scoliosis: options for surgical management. Orthopedic Clinics of North America. 2003;34(2):269–279.
    1. Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. The Spine Journal. 2006;6(4):435–443.
    1. Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM. A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine. 2010;35(26):S322–S330.
    1. Youssef JA, McAfee PC, Patty CA, et al. Minimally invasive surgery: lateral approach interbody fusion: results and review. Spine. 2010;35(26):S302–S311.
    1. Smith WD, Christian G, Serrano S, Malone KT. A comparison of perioperative charges and outcome between open and mini-open approaches for anterior lumbar discectomy and fusion. Journal of Clinical Neuroscience. 2012;19(5):673–680.
    1. Uribe JS, Arredondo N, Dakwar E, Vale FL. Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. Journal of Neurosurgery. 2010;13(2):260–266.
    1. Uribe JS, Dakwar E, Le TV, Christian G, Serrano S, Smith WD. Minimally invasive surgery treatment for thoracic spine tumor removal: a mini-open, lateral approach. Spine. 2010;35(26):S347–S354.
    1. Le TV, Smith DA, Greenberg MS, Dakwar E, Baaj AA, Uribe JS. Complications of lateral plating in the minimally invasive lateral transpsoas approach. Journal of Neurosurgery. 2012;16(3):302–307.
    1. Mundis GM, Akbarnia BA, Phillips FM. Adult deformity correction through minimally invasive lateral approach techniques. Spine. 2010;35(26):S312–S321.
    1. McAfee PC, Phillips FM, Andersson G, et al. Minimally invasive spine surgery. Spine. 2010;35:S271–S273.
    1. Rodgers WB, Gerber EJ, Rodgers JA. Lumbar fusion in octogenarians: the promise of minimally invasive surgery. Spine. 2010;35:S355–S360.
    1. Rodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine. 2011;36(1):26–32.
    1. Tohmeh AG, Rodgers WB, Peterson MD. Dynamically evoked, discrete-threshold electromyography in the extreme lateral interbody fusion approach. Journal of Neurosurgery. 2011;14(1):31–37.
    1. Rodgers WB, Cox CS, Gerber EJ. Early complications of extreme lateral interbody fusion in the obese. Journal of Spinal Disorders and Techniques. 2010;23(6):393–397.
    1. Smith WD, Dakwar E, Le TV, Christian G, Serrano S, Uribe JS. Minimally invasive surgery for traumatic spinal pathologies: a mini-open, lateral approach in the thoracic and lumbar spine. Spine. 2010;35(26):S338–S346.
    1. Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH. Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine. 2007;32(20):2238–2244.
    1. Cho KJ, Suk SI, Park SR, et al. Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine. 2007;32(20):2232–2237.
    1. Baker JK, Reardon PR, Reardon MJ, Heggeness MH. Vascular injury in anterior lumbar surgery. Spine. 1993;18(15):2227–2230.
    1. Rajaraman V, Vingan R, Roth P, Heary RF, Conklin L, Jacobs GB. Visceral and vascular complications resulting from anterior lumbar interbody fusion. Journal of Neurosurgery. 1999;91(1):60–64.
    1. Christensen FB, Bünger CE. Retrograde ejaculation after retroperitoneal lower lumbar interbody fusion. International Orthopaedics. 1997;21(3):176–180.
    1. Pateder DB, Kebaish KM, Cascio BM, Neubaeur P, Matusz DM, Kostuik JP. Posterior only versus combined anterior and posterior approaches to lumbar scoliosis in adults: a radiographic analysis. Spine. 2007;32(14):1551–1554.
    1. Sharma AK, Kepler CK, Girardi FP, Cammisa FP, Huang RC, Sama AA. Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report. Journal of Spinal Disorders and Techniques. 2011;24(4):242–250.
    1. Acosta FL, Liu J, Slimack N, Moller D, Fessler R, Koski T. Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study. Journal of Neurosurgery. 2011;15(1):92–96.
    1. Dakwar E, Cardona RF, Smith DA, Uribe JS. Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurgical Focus. 2010;28(3):p. E8.
    1. Anand N, Rosemann R, Khalsa B, Baron EM. Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis. Neurosurgical Focus. 2010;28(3):p. E6.
    1. Wang MY, Mummaneni PV. Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes. Neurosurgical Focus. 2010;28(3):p. E9.
    1. Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS. Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurgical Focus. 2010;28(3):p. E7.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere