Fusion For Degenerative Scoliosis Research Articles

Enhanced Recovery After Surgery Reduces Postoperative Opioid Use and 90-Day Readmission Rates After Open Thoracolumbar Fusion for Adult Degenerative Deformity.

The role of enhanced recovery after surgery (ERAS) pathways implementation has not been previously explored in adult deformity patients. To determine the impact of ERAS pathways implementation in adult patients undergoing open thoraco-lumbar-pelvic fusion for degenerative scoliosis on postoperative outcome, opioid consumption, and unplanned readmission rates. In this retrospective single-center study, we included 124 consecutive patients who underwent open thoraco-lumbar-pelvic fusion from October 2016 to February 2019 for degenerative scoliosis. Primary outcomes consisted of postoperative supplementary opioid consumption in morphine equivalent dose (MED), postoperative complications, and readmission rates within the postoperative 90-d window. There were 67 patients in the ERAS group, and 57 patients served as pre-ERAS controls. Average patient age was 69 yr. The groups had comparable demographic and intraoperative variables. ERAS patients had a significantly lower rate of postoperative supplemental opioid consumption (248.05vs 314.05 MED, P=.04), a lower rate of urinary retention requiring catheterization (5.97%vs 19.3%, P=.024) and of severe constipation (1.49%vs 31.57%, P<.0001), and fewer readmissions after their surgery (2.98%vs 28.07%, P=.0001). A comprehensive multidisciplinary approach to complex spine surgery can reduce opioid intake, postoperative urinary retention and severe constipation, and unplanned 90-d readmissions in the elderly adult population.

Correction of sagittal plane deformity and predictive factors for a favourable radiological outcome following multilevel posterior lumbar interbody fusion for degenerative scoliosis

Correction of sagittal plane deformity and predictive factors for a favourable radiological outcome following multilevel posterior lumbar interbody fusion for degenerative scoliosis

Visual loss after spine surgery

Incidence of perioperative visual loss ranges from 0.06% to 0.2% with the most common cause as ischemic optic neuropathy. We report one-year follow up of a 50-years-old hypertensive housewife who underwent lumbar decompression and fusion for degenerative scoliosis, but woke up with painless unilateral visual loss. Fundus examination was normal. Her visual acuity improved from initial finger counting close to face to finger counting at 3 m at 1 year. Identification of high risk patients may help in appropriate preoperative counselling, prevention and early recognition of this devastating complication.

Limited decompression, fixation, and fusion for degenerative scoliosis with vertebral stenosis

Objective To evaluate the efficiency of limited decompression, fixation, and fusion for degenerative scoliosis with vertebral stenosis. Methods From January 2001 to January 2008, 36 patients with degenerative scoliosis with vertebral stenosis were treated in our hospital. There were 2 males and 34 females. The age was from 51 to 76 years with an average of 62.3 years. X-ray, CT, MR examination were performed preoperatively for all the cases, 5 cases underwent myelography. Preoperative Cobb's angle, focal lordosis, the distance between C_7 plumb line(C_7PL) and upper edge of S_1 vertebral body (SVA), and the distance between C_7PL and center sacral vertical line(CSVL) were 24.0°±10.2°, 22.6°±11.2°, (7.8±6.6) cm and (6.9±5.8) cm respectively. Limited decompression, pedicle screw internal fixation and fusion were carried out for patients, VAS and SF-36 scored system were used to evaluate surgery effects. Results The mean followup period was 2.4 years (range, 1.2-4 years) and no patients were lost during follow-up. The mean surgery time was 130 min (range, 115-164 min) with an average bleeding amount of 625 ml (range, 450-870 ml). Compared to preoperation, Cobb's angle (10.6°±8.5°, 8.9°±5.3°), focal lordosis (25.6°±14.3°, 31.8°±13.4°), SVA[(0.5±3.4) cm, (-1.2±2.7) cm], and CSVL [(2.9±1.4) cm, (1.7±1.2) cm] were significantly improved at postoperation and final follow-up through statistics of SPSS 13.0 software. Loss of correction happened in one case. No collapse of the disc height occurred, neither did nerve root injuries nor fracture of the fixation system. Conclusion Limited decompression, pedicle screw fixation and fusion are testified efficient for degenerative scoliosis with vertebral stenosis, individualized surgery design should be made according to clinical symptoms, signs and imaging features to expect a satisfactory result. Key words: Lumbar vertebrae; Spinal stenosis; Scoliosis