Surgical Treatment of Adult Lumbar Scoliosis - Is Anterior Apical Release and Fusion Necessary?
d - Medtronic Sofamor Danek
e- Medtronic Sofamor Danek
Purpose: To analyze surgical outcomes in adult lumbar scoliosis following two different surgical techniques with regard to whether an anterior apical release and fusion is necessary.
Methods: Thirty-eight patients with an average age of 49.7 years (range 22-77) and minimum 2-year follow-up (average 3.8 years, range 2-10) were surgically treated for a lumbar scoliosis using two different techniques. In Group I (n=18), anterior release was performed via a thoracoabdominal approach followed by posterior instrumentation. In Group II (n=20), posterior correction and instrumentation was performed followed by anterior column support through a separate anterior paramedian retroperitoneal or posterior transforaminal approach. Preoperative and postoperative radiographs were evaluated and normalized SRS scores were used for clinical evaluation.
Results: (See table) Groups I and II were well-matched preoperatively, except Group I patients had somewhat more lumbar curve flexibility (P<0 .02) and thoracolumbar kyphosis (P<0.02). Postoperatively, at last follow-up, there were no significant statistical differences with regard to Cobb angle changes of the lumbar curve (P="0.56)." fractional lower C7 plumbline center sacral vertical line posterior superior endplate S1 sagittal angles proximal junction T10-L2 T12-S1 Postoperative SRS scores ultimate follow-up significantly higher in Group II (P<0.05). There three pseudarthroses I only one II.
Conclusion: For adult lumbar scoliosis, performing an apical release and fusion via an open thoracoabdominal approach does not demonstrate any radiographic improvement over posterior fixation alone, which appears to have superior clinical outcomes. Lumbosacral fusion should be performed via a separate anterior paramedian approach or a posterior transforaminal approach.
| Average Values |
Group I
|
Group II
|
P-value
|
| Age at surgery |
49.2
|
50.2
|
0.75
|
| Lumbar curve (degrees) | |||
| Preoperative |
60.7
|
55.8
|
0.19
|
| Flexibility (%) |
26.9
|
37.5
|
‹0.02
|
| Final follow-up |
37.6
|
32.3
|
0.19
|
| Correction rate (%) |
39.0
|
42.1
|
0.50
|
| Fractional lumbar curve (degrees) | |||
| Preoperative |
34.7
|
31.9
|
0.39
|
| Final follow-up |
22.2
|
19.1
|
0.34
|
| Correction rate (%) |
43.5
|
39.0
|
0.41
|
| C7-CVSL (mm) | |||
| Preoperative |
24.8
|
22.6
|
0.70
|
| Final follow-up |
18.6
|
24.0
|
0.30
|
| Sagittal Cobb angles at the proximal junction (degrees) | |||
| Preoperative |
2.06
|
1.90
|
0.93
|
| Final follow-up |
11.3
|
11.5
|
0.95
|
| Thoracolumbar kyphosis: T10-L2 (degrees) | |||
| Preoperative |
27.7
|
14.8
|
‹0.02
|
| Final follow-up |
21.4
|
10.9
|
0.06
|
| Lumbar lordosis; T12-S1 (degrees) | |||
| Preoperative |
-42.1
|
-40.2
|
0.80
|
| Final follow-up |
-53.2
|
-49.3
|
0.56
|
| C7-SSVL (mm) | |||
| Preoperative |
2.11
|
4.20
|
0.87
|
| Postoperative |
-2.94
|
5.80
|
0.52
|
| SRS-score (%) | |||
| Preoperative |
61
|
65
|
0.36
|
| Postoperative |
70
|
78
|
‹0.05
|