Treatment of degenerative lumbar scoliosis with selective segmental transforaminal lumbar interbody fusion and posterior spinal fusion.

Abstract

Listen

Translate article

Objective To investigate the treatment outcome of degenerative lumbar scoliosis (DIS) with selective segmental transforaminal lumbar interbody fusion (TLIF) and posterior spinal fusion. Methods Forty-six patients with DIS treated by selective segmental TLIF and posterior spinal fusion were studied ret-rospectively. There were 14 males and 32 females, with a mean age of 66.4 years (range, 41-78). Posterior spinal fusion was performed 7 segments in 5 cases, 5 in 4, 4 in 4, 3 in 12, 2 in 16, and 1 in 5 cases. The in-dications for TLIF of motion segment included: rigid kyphosis in the lumbar spine, significant vertebral trans-lation in any orientation, segmental instability, and significant upper endplate obliquities of L3 or L4 All pa-tients were followed with a mean duration of 3.6 years postoperatively. The imaging evaluation included Cobb angle of scoliosis, lumbar lordosis angle and segmental lordosis angle. The low-back and lower-extremity clinical symptoms were evaluated with JOA score. Results The mean preoperative Cobb angle of 31.7°±14.4° was significantly corrected to 10.2°±6.5°at the final follow-up (t=15.26, P< 0.05), and the correction rate was 67.8%. The mean preoperative lumbar lordosis angle of 27.5°±12.6° was also significantly corrected to 39.3°±9.7°(t=12.17, P< 0.05), and the correction rate was 44.4%. The mean preoperative segmental lordo-sis angle of 6.5°±5.1° in TLIF segment was increased to 11.6°±5.9°. The segmental deformity and vertebral translation were corrected significantly. The mean preoperative JOA score of 14.1±4.2 was significantly in-creased to 22.2±4.8 (t=11.45, P< 0.01). Besides, there was a significant positive correlation between the fi-nal increment of JOA score and the increment in lumbar lordosis angle (r=0.61,P=0.02). Conclusion Se-lective segmental TLIF is helpful in correcting lumbar lordosis, segmental deformity and translation, and thus obtaining better outcome of posterior spinal fusion for the treatment of DLS. Key words: Spinal fusion; Scoliosis; Lumbar vertebrae