Posterior-only Approach With Selective Segmental TLIF for Degenerative Lumbar Scoliosis

Abstract

Forty-six patients with degenerative lumbar scoliosis, and treated with selective segmental transforaminal lumbar interbody fusion (TLIF), were studied retrospectively. To investigate the surgery outcomes of the posterior-only approach with selective segmental TLIF for the treatment of degenerative lumbar scoliosis. Degenerative lumbar scoliosis usually occurs late in the life of patients with no history of scoliosis. TLIF has been successfully used in the surgical treatment of other degenerative diseases of the lumbar spine. Forty-six patients with degenerative lumbar scoliosis and treated with selective segmental TLIF were studied retrospectively. There were 14 male and 32 female patients, with a mean age of 66.4 years. The indications for TLIF of the motion segment included segmental kyphosis in the lumbar spine, significant vertebral translation in any orientation, segmental instability, and significant upper endplate obliquities of L3 or L4. All the patients were followed for a mean duration of 42 months postoperatively. Radiographic evaluation included Cobb angle of scoliosis, lumbar lordosis angle, and segmental lordosis angle. The clinical outcomes were assessed by means of Japanese Orthopedic Association score and patient satisfaction index. The mean preoperative Cobb angle of 31.7 ± 14.4 degrees was corrected to 10.2 ± 6.5 degrees at the final follow-up (t = 15.262, P < 0.001), and the correction rate was 67.8%. The mean preoperative lumbar lordosis angle of -27.5 ± 12.6 degrees was corrected to -39.3 ± 9.7 degrees (t = 12.165, P < 0.001), and the correction rate was 44.4%. The mean preoperative segmental lordosis angle of -6.5 ± 5.1 degrees in the TLIF segment was increased to -11.6 ± 5.9 degrees, and the correction rate was 80%. Besides, the segmental deformity and vertebral translation were also corrected. The mean preoperative Japanese Orthopedic Association score of 14.1 ± 4.2 was increased to 22.2 ± 4.8 (t = 11.453, P < 0.001), and 81% of patients would undergo this surgery again with the same results. Selective segmental TLIF is helpful in correcting lumbar lordosis, segmental deformity, and translation, and thus obtaining satisfactory outcome in the treatment of degenerative lumbar scoliosis.