Multilevel XLIFs, TLIFs and Grade 2 Posterior Osteotomies for Surgical Correction of Compensated Sagittal Imbalance: Outcomes in 25 Consecutive Adult Degenerative Deformities at Minumum 2 Years Follow-up

Abstract

Introduction Sagittal imbalance in the adult degenerative spine requires surgical correction to improve pain, mobility and quality of life. Aim of our surgery is to obtain a harmonic, balanced sagittal profile operating a series of adult degenerative kyphoscoliosis by means of XLIFs, TLIFs, SPOs and posterior pedicle screws. Actually, XLIF seems to be the less invasive alternative to PSO to restore LL and achieve anterior fusion, while Grade 2 posterior osteotomies can be useful to further decrease kyphosis. Material and Methods We treated by XLIFs, SPOs and pedicle instrumentations 25 thoraco-lumbar and lumbar degenerative deformities, characterized by a sagittal compensated imbalance (SVA < 50mm), with or without coronal deformity, and distinguished according to the SRS-Schwab classification. All patients were submitted to X-ray screening during pre, post-operative and follow-up periods. Results Mean age was 64 (50–74; M/F 1: 4). Sixteen deformities were type L and 9 type N. Loss of LL was moderate (+) in 14 cases and marked (++) in 11. We performed 50 XLIFs, 15 TLIFs, 48 SPOs. Complication rate was minimal. PT, LL, SVA and TK improved ( p < 0.05), post-operative values were similar to those pre-operatively calculated in 90% of cases and clinical follow-up (mean 29.5; range 24–36), scored using VAS and ODI, was satisfactory in all cases, except for two due to sacro-iliac pain. Conclusion Current follow-up does not allow definitive conclusions. However, the surgical approach proposed seems to be a viable choice usable in these compensated adult deformities, avoiding risks and complications of aggressive PSOs.