Abstract
Purpose
Limited data is available in the literature on the radiographic results of multilevel posterior lumbar interbody fusion (MPLIF) in the treatment of degenerative scoliosis. The objective of our study was to evaluate the segmental and global correction achieved with MPLIF in the treatment of degenerative scoliosis.
Methods
Between 2009 and 2014, 42 patients underwent correction of degenerative scoliosis with MPLIF. Several radiological parameters were measured pre- and post-operatively by two independent observers. A statistical analysis was performed to assess the inter-observer reliability of the measurements and to determine the degree of segmental correction achieved at each intervertebral disc. Using sagittal vertical axis (SVA) less than 47 mm; lumbar lordosis (LL) within 11° of pelvic incidence (PI); and pelvic tilt (PT) no more than 22° as radiological criteria for procedural acceptability, we determined predictive factors for a favourable radiological outcome.
Results
Forty-two patients (34 female) were included in our study. The average amount of correction per segment was 6.2°. The overall correction achieved with MPLIF was 16.6°. Twenty-six of the 42 patients (61.9 %) had post-operative SVA values less than 47 mm. Nineteen of the 42 patients (45.2 %) had average post-operative LL within 11° of the PI. Sixteen of the 42 patients (38.1 %) had PT less than 22°. Younger age, female gender and a low pre-operative PT were significantly associated with the attainment of a satisfactory sagittal alignment.
Conclusion
Our results demonstrate that a satisfactory correction can be achieved in degenerative scoliosis with MPLIF. In addition, our results show that it is significantly more likely to achieve a satisfactory radiological outcome in younger, female patients with low pre-operative PT.
Similar content being viewed by others
References
Palmisani M, Dema E, Cervellati S (2013) Surgical treatment of adult degenerative scoliosis. Eur Spine J 22(Suppl 6):S829–S833. doi:10.1007/s00586-013-3012-1
Jagannathan J, Sansur CA, Oskouian RJ Jr, Fu KM, Shaffrey CI (2009) Radiographic restoration of lumbar alignment after transforaminal lumbar interbody fusion. Neurosurgery 64:955–963. doi:10.1227/01.NEU.0000343544.77456.46 (discussion 963–954)
Zeng Y, White AP, Albert TJ, Chen Z (2012) Surgical strategy in adult lumbar scoliosis: the utility of categorization into 2 groups based on primary symptom, each with 2-year minimum follow-up. Spine (Phila Pa 1976) 37:E556–E561. doi:10.1097/BRS.0b013e31824af5c6
Silva FE, Lenke LG (2010) Adult degenerative scoliosis: evaluation and management. Neurosurg Focus 28:E1. doi:10.3171/2010.1.FOCUS09271
Cho KJ, Suk SI, Park SR, Kim JH, Kim SS, Lee TJ, Lee JJ, Lee JM (2008) Short fusion versus long fusion for degenerative lumbar scoliosis. Eur Spine J 17:650–656. doi:10.1007/s00586-008-0615-z
Wang G, Hu J, Liu X, Cao Y (2015) Surgical treatments for degenerative lumbar scoliosis: a meta analysis. Eur Spine J. doi:10.1007/s00586-015-3942-x
Aebi M (2005) The adult scoliosis. Eur Spine J 14:925–948. doi:10.1007/s00586-005-1053-9
Phillips FM, Isaacs RE, Rodgers WB, Khajavi K, Tohmeh AG, Deviren V, Peterson MD, Hyde J, Kurd M (2013) Adult degenerative scoliosis treated with XLIF: clinical and radiographical results of a prospective multicenter study with 24-month follow-up. Spine (Phila Pa 1976) 38:1853–1861. doi:10.1097/BRS.0b013e3182a43f0b
Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS (2010) Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurg Focus 28:E7. doi:10.3171/2010.1.FOCUS09263
Costanzo G, Zoccali C, Maykowski P, Walter CM, Skoch J, Baaj AA (2014) The role of minimally invasive lateral lumbar interbody fusion in sagittal balance correction and spinal deformity. Eur Spine J 23(Suppl 6):699–704. doi:10.1007/s00586-014-3561-y
Lippman CR, Spence CA, Youssef AS, Cahill DW (2003) Correction of adult scoliosis via a posterior-only approach. Neurosurg Focus 14:e5
Whitecloud TS 3rd, Roesch WW, Ricciardi JE (2001) Transforaminal interbody fusion versus anterior-posterior interbody fusion of the lumbar spine: a financial analysis. J Spinal Disord 14:100–103
Villavicencio AT, Burneikiene S, Bulsara KR, Thramann JJ (2006) Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability. J Spinal Disord Tech 19:92–97. doi:10.1097/01.bsd.0000185277.14484.4e
Rothenfluh DA, Koenig M, Stokes OM, Behrbalk E, Boszczyk BM (2014) Access-related complications in anterior lumbar surgery in patients over 60 years of age. Eur Spine J 23(Suppl 1):S86–S92. doi:10.1007/s00586-014-3211-4
Klezl Z, Swamy GN, Vyskocil T, Kryl J, Stulik J (2014) Incidence of vascular complications arising from anterior spinal surgery in the thoraco-lumbar spine. Asian Spine J 8:59–63. doi:10.4184/asj.2014.8.1.59
Kotwal S, Pumberger M, Hughes A, Girardi F (2011) Degenerative scoliosis: a review. HSS J 7:257–264. doi:10.1007/s11420-011-9204-5
Liu X, Wang Y, Qiu G, Weng X, Yu B (2014) A systematic review with meta-analysis of posterior interbody fusion versus posterolateral fusion in lumbar spondylolisthesis. Eur Spine J 23:43–56. doi:10.1007/s00586-013-2880-8
Kim KT, Lee SH, Lee YH, Bae SC, Suk KS (2006) Clinical outcomes of 3 fusion methods through the posterior approach in the lumbar spine. Spine (Phila Pa 1976) 31:1351–1357. doi:10.1097/01.brs.0000218635.14571.55 (discussion 1358)
Wang JC, Mummaneni PV, Haid RW (2005) Current treatment strategies for the painful lumbar motion segment: posterolateral fusion versus interbody fusion. Spine (Phila Pa 1976) 30:S33–S43
Suk SI, Lee CK, Kim WJ, Lee JH, Cho KJ, Kim HG (1997) Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976) 22:210–219 (discussion 219–220)
Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, Boachie-Adjei O, Burton DC, Akbarnia BA, Mundis GM, Ames CP, Kebaish K, Hart RA, Farcy JP, Lafage V, International Spine Study G (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 38:E803–E812. doi:10.1097/BRS.0b013e318292b7b9
Schwab F, Patel A, Ungar B, Farcy JP, Lafage V (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35:2224–2231. doi:10.1097/BRS.0b013e3181ee6bd4
Jean L (2014) Influence of age and sagittal balance of the spine on the value of the pelvic incidence. Eur Spine J 23:1394–1399. doi:10.1007/s00586-014-3207-0
Boissiere L, Bourghli A, Vital JM, Gille O, Obeid I (2013) The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery. Eur Spine J 22:1339–1345. doi:10.1007/s00586-013-2711-y
Rose PS, Bridwell KH, Lenke LG, Cronen GA, Mulconrey DS, Buchowski JM, Kim YJ (2009) Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine (Phila Pa 1976) 34:785–791. doi:10.1097/BRS.0b013e31819d0c86
Baghdadi YM, Larson AN, Dekutoski MB, Cui Q, Sebastian AS, Armitage BM, Nassr A (2014) Sagittal balance and spinopelvic parameters after lateral lumbar interbody fusion for degenerative scoliosis: a case-control study. Spine (Phila Pa 1976) 39:E166–E173. doi:10.1097/BRS.0000000000000073
Brown KM, Ludwig SC, Gelb DE (2004) Radiographic predictors of outcome after long fusion to L5 in adult scoliosis. J Spinal Disord Tech 17:358–366 (00024720-200410000-00002 [pii])
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None of the authors has any potential conflict of interest.
Rights and permissions
About this article
Cite this article
Sabou, S., Tseng, TH.J., Stephenson, J. et al. Correction of sagittal plane deformity and predictive factors for a favourable radiological outcome following multilevel posterior lumbar interbody fusion for mild degenerative scoliosis. Eur Spine J 25, 2520–2526 (2016). https://doi.org/10.1007/s00586-015-4338-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-015-4338-7