Clinical value of oblique lateral interbody fusion in the treatment of adult degenerative scoliosis

Abstract

Objective To evaluate the clinical outcomes of oblique lateral interbody fusion (OLIF) in the treatment of adult degenerative scoliosis (ADS). Methods From January 2015 to May 2016, 17 ADS patients, 4 males and 13 females were enrolled with ages from 46 to 80 (average 69.5±9.2 years). The Cobb angle of all was greater than 10°. According to Lenke-Silva classification systems: I level, 2 cases, decompression alone; II level, 2 cases, decompression and limited instrumented spinal fusion; III levels, 4 cases, decompression and lumbar curve instrumented fusion; IV levels, 5 cases, decompression with anterior and posterior spinal instrumented fusion; V level, 4 cases, thoracic instrumentation and fusion extension. The operation time, blood loss, blood transfusion, and preoperative and postoperative complications were recorded. Clinical and radiological outcomes were evaluated using visual analogue scale (VAS), Oswestry disability questionnaire (ODI) scores, sagittal vertical axis (SVA) and coronal Cobb. All cases were followed up in 3, 6, 12 and 24 months. Results All of 17 cases underwent OLIF, one level 4 cases, two levels 2 cases, three levels 7 cases and four levels 4 cases. Alone OLIF was 5 cases (2 case of I level, 1 case of II level, 1 case of III level and 1 case of IV level). OLIF combined with posterior approach was 12 cases and the interval time were 1-2 weeks, the mean were 1.7±0.5 weeks. Among these 12 cases, posterior fixation was 6 cases, posterior fixation and decompression was 2 cases, and L5/S1 interbody fusion was 4 cases. The operation lasted for 50-460 min, with a mean duration of 230.6±132.0 min. Blood loss during the operation was 30-640 ml, with a mean of 306.5±213.8 ml. No patient had blood transfusion. The follow-up was 12-28 months and the mean was 17.9±4.5 months. The preoperative Cobb angles were 16.2°-37.7°, the mean was 29.1°±6.4°. The postoperative Cobb angle were 1.5°-10.2°, and the mean were 5.6°±2.4°. The Cobb of all cases improved significantly. The SVA was returned to the normal level in 4 cases of Lenke-Silva V level. The VAS and ODI score decreased from 7.1±0.7 preoperatively to 2.4±0.9 at last follow-up, and from 37.9±2.5 to 10.9±3.0, respectively, and both of them were improved significantly. 2 cases of OLIF had cage malposition. Left hip flexor weakness occurred in 5 cases and recovered completely within 2 weeks. Left anterior thigh pain occurred in 1 case and disappeared within 2 weeks. Left sympathetic chain injury happened in 1 case and recovered at last follow-up. Conclusion OLIF as a management of ADS showed excellent short-term outcomes. Clinical and radiological results, such as VAS, ODI and Cobb angle, were improved in all cases. OLIF will be a good choice for the treatment of ADS. Key words: Lumbar vertebrae; Adult; Scoliosis; Spinal fusion