Long-term clinical outcomes of selective segmental transforaminal lumbar interbody fusion and posterior spinal fusion for degenerative lumbar scoliosis

Abstract

To explore the surgical techniques and long-term clinical outcomes of degenerative scoliosis (DS) with selective segmental transforaminal lumbar interbody fusion (TLIF) and posterior spinal fusion. Ninety-five patients with adult degenerative lumbar scoliosis undergoing posterior long fusion at our department from January 1999 to December 2007 were analyzed retrospectively. The average follow-up period was 7.8 (5-13) years. The clinical outcomes of Oswestry disability index (ODI), visual analog scale (VAS), patient satisfaction and such radiographic parameters as Cobb angle, apical vertebra translation (AVT), Nash-Moe grade, lumbar lordosis (LL) and thoracolumbar kyphosis (TLK) were evaluated. The clinical outcomes of ODI score and VAS significantly improved at the last visit (P < 0.05). The ODI score was 32.2 ± 8.6 before surgery and 11.1 ± 6.8 at the last visit. The VAS was 8.9 ± 2.0 before surgery and 2.0 ± 1.2 at the last visit. Patient satisfaction was 88.2% (84/95) at the last visit. At the final evaluation, Cobb's angle, apical vertebra translation and Nash-Moe grades decreased with a statistically significant difference (P < 0.001) compared with preoperative parameters.Lordotic angle had a significant increase than preoperative angle (P < 0.001). Thoracolumbar kyphosis showed no significant change (P > 0.05). Besides, a significant positive correlation existed between the decrease of ODI score and the increment of lumbar lordotic angle (r = 0.62, P = 0.01) .Long-term complications included broken rod (n = 2), coronal junctional scoliosis (n = 4), L5-S1 spondylolisthesis (n = 2), L5-S1 restenosis (n = 5). And 11 patients underwent reoperation. A combination of selective segmental TLIF and posterior spinal fusion is both safe and effective for degenerative scoliosis and excellent long-term clinical outcomes may be achieved. And selective segmental TLIF can facilitate solid fusion, improvement of lumbar lordosis, better correction of lateral spondylolisthesis and asymmetric disc space so as to yield better corrective effects and long-term clinical outcomes.