Abstract
BackgroundTraditional approaches to deformity correction of degenerative lumbar scoliosis include anterior-posterior approaches and posterior-only approaches. Most patients are treated with posterior-only approaches because the high complication rate of anterior approach. Our purpose is to compare and assess outcomes of combined anterior lumbar interbody fusion and instrumented posterolateral fusion with posterior alone approach for degenerative lumbar scoliosis with spinal stenosis.MethodsBetween November 2002 and November 2011, a total of 110 patients with degenerative spinal deformity and curves measuring over 30°were included. Of the 110 patients who underwent surgery, 56 underwent the combined anterior and posterior approach and 54 underwent posterior surgery at our institution. The following were the indications of anterior lumbar interbody fusion: (1) rigid or frank lumbar kyphosis, (2) anterior or lateral bridged traction osteophytes, (3) gross coronal and sagittal deformity or imbalance, and (4) severe disc space narrowing that is not identifiable when performing posterior or transforaminal lumbar interbody fusion. The clinical outcomes were evaluated using the Oswestry disability index and the visual analog scale. The status of fusion were assessed according to the radiographic findings.ResultsAll patients received clinical and radiographic follow-up for a minimum of 24 months, with an average follow-up of 53 months (range, 26–96 months). At the final follow-up, the mean ODI score improved from 28.8 to 6.4, and the mean back/leg VAS, from 8.2/5.5 to 2.1/0.9 in AP group and the mean ODI score improved from 29.1 to 6.2, and the mean back/leg VAS, from 9.0/6.5 to 2.3/0.5 in P group. The mean scoliotic angle changed from 41.3° preoperatively to 9.3°, and the lumbar lordotic angle, from 3.1° preoperatively to 35.7°in AP group and the mean scoliotic angle from 38.5 to 21.4 and the lumbar lordotic angle from 6 to 15.8 in P group. There were significant differences in sagittal (P = 0.009) and coronal (P = 0.02) plane correction between the two groups.ConclusionsOur results demonstrate that combined anterior lumbar interbody fusion and instrumented posterolateral fusion for adult degenerative lumbar scoliosis effectively improves sagittal and coronal plane alignment than posterior group and both group were effectively improves clinical scores.
Highlights
Traditional approaches to deformity correction of degenerative lumbar scoliosis include anterior-posterior approaches and posterior-only approaches
No study has yet mentioned the indications of combined anterior lumbar interbody fusion and instrumented posterolateral fusion for degenerative lumbar scoliosis with spinal stenosis and compare and assess outcomes with posterior alone approach
The mean preoperative lumbar lordosis angle increased from 3.1° to 35.7°, demonstrating a mean improvement of 32.6° (P = 0.009).In P group, the average preoperative coronal Cobb angle was 38.5°, which decreased to 21.4° postoperatively, demonstrating a significant mean scoliosis correction of 44%
Summary
Traditional approaches to deformity correction of degenerative lumbar scoliosis include anterior-posterior approaches and posterior-only approaches. Our purpose is to compare and assess outcomes of combined anterior lumbar interbody fusion and instrumented posterolateral fusion with posterior alone approach for degenerative lumbar scoliosis with spinal stenosis. Traditional approaches to deformity correction of degenerative lumbar scoliosis include anterior-posterior approaches and, more commonly, posterior-only approaches. No study has yet mentioned the indications of combined anterior lumbar interbody fusion and instrumented posterolateral fusion for degenerative lumbar scoliosis with spinal stenosis and compare and assess outcomes with posterior alone approach
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