Posterior Lumbar Interbody Fusion in Multilevel Lumbar Spinal Stenosis Associated with Degenerative Scoliosis

Abstract

Study Design : In this study, 18 patients undergoing posterior lumbar interbody fusion for multilevel lumbar spinal stenosis associated with degenerative scoliosis were reviewed retrospectively. Objectives : To assess the effectiveness of the cage-instrumented posterior lumbar interbody fusion in multilevel lumbar spinal stenosis associated with degenerative scoliosis. Summary of literature Review : Degenerative lumbar scoliosis with the problems of neurogenic claudication, mechanical back pain and spinal deformity present a challenge for treatment. Materials and Methods : We reviewed 18 surgical cases of multilevel lumbar spinal stenosis with degenerative scoliosis from March 1995 to April 2000 with an average follow up period of 2.9 years. We assessed the radiographic results of scoliotic angle correction and sagittal angle correction of the maximum curve and fused segment and disc height restoration. Clinical results were evaluated according to the Kirkaldy-Willis criteria. Results : Mean scoliotic angle at preoperative, postoperative and final follow-up (maximum curve/fused segment) was 17.7-6.17.3。 /15.0-5.8-6.1。respectively. Mean sagittal angle corresponding to each period was 12.1-34.1-32.7。 /8.3-27.0-26.0。respectively. Mean disc height corresponding to each period was 22.9-42.4-40.5% respectively. The clinical result was analyzed as 15 satisfactory (83.3%), 3 fair (16.7%) and no poor. Fusion success was achieved in all patients. There were no serious complications except one case of fusion extension distally and no significant curve progression within follow-up period. Conclusions : The cage-posterior lumbar interbody fusion in multilevel lumbar spinal stenosis with degenerative scoliosis was effective for correction of scoliotic and sagittal deformity and restoration of disc height with resultant foraminal patency, provided relatively high clinical success and in situ fusion success in all cases even over multiple fusion levels, and can be an alternative among surgical treatments of this complex disease.