Radiographic and Clinical Outcomes following Combined Oblique Lumbar Interbody Fusion and Lateral Instrumentation for the Treatment of Degenerative Spine Deformity: A Preliminary Retrospective Study

Objective The authors recently used a combination of minimally invasive oblique lumbar interbody fusion (OLIF) and lateral fixation for the treatment of degenerative spine deformity. The early results were promising. Radiographic and clinical results as well as complications were retrospectively assessed in the current study. Methods Eleven patients with degenerative spine deformity underwent combined OLIF and lateral instrumentation without real-time electromyography (EMG) monitoring. Radiographic measurements including coronal Cobb angle, central sacral vertebral line (CSVL), lumbar lordosis (LL), sagittal vertebral axis (SVA), pelvic tilt (PT), and LL-PI (pelvic incidence) mismatch were taken preoperatively and at last follow-up postoperatively in all patients. Concurrently, the visual analog score (VAS) for back pain and the Oswestry Disability Index (ODI) score were used to assess clinical outcomes. The fusion rate of OLIF cage, total blood loss, operation time, hospital stay, and complications were also evaluated. Results At last follow-up, all patients who underwent combined OLIF and lateral instrumentation achieved statistically significant improvement in coronal Cobb angle (from 15.3±4.7° to 5.9±3.1°, p < 0.01), LL (from 34.3±9.0° to 48.2±8.5°, p < 0.01), PT (from 24.2±9.6° to 16.2±6.0°, p < 0.01), LL-PI mismatch (from 15.4±8.7° to 7.0±3.7°, p < 0.01), CSVL (from 2.1±2.2cm to 0.7±0.9cm, p = 0.01), and SVA (from 7.0±3.9cm to 2.9±1.8cm, p < 0.01). VAS for back pain (from 6.9±1.4 to 2.0±0.9, p < 0.05) and ODI (from 39.5±3.1 to 21.9±3.6, p < 0.01) improved significantly after surgery. Conclusions A combination of OLIF and lateral instrumentation is an effective and safety means of achieving correction of both coronal and sagittal deformity, resulting in improvement of quality of life in patients with degenerative spine deformity. It is a promising way to treat patients with moderate degenerative spine deformity.

[1]  J. Uribe,et al.  Preservation or Restoration of Segmental and Regional Spinal Lordosis Using Minimally Invasive Interbody Fusion Techniques in Degenerative Lumbar Conditions: A Literature Review , 2016, Spine.

[2]  Xiaoguang Liu,et al.  Reconstruction of the Upper Cervical Spine Using a Personalized 3D-Printed Vertebral Body in an Adolescent With Ewing Sarcoma , 2016, Spine.

[3]  R. Mobbs,et al.  Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity , 2015, Journal of Clinical Neuroscience.

[4]  S. Kishida,et al.  Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lateral Interbody Fusion for Degenerated Lumbar Spinal Kyphoscoliosis , 2015, Asian spine journal.

[5]  S. Matsuda,et al.  Effect of Indirect Neural Decompression Through Oblique Lateral Interbody Fusion for Degenerative Lumbar Disease , 2015, Spine.

[6]  Zachary J. Tempel,et al.  Radiographic and clinical outcomes following combined lateral lumbar interbody fusion and posterior segmental stabilization in patients with adult degenerative scoliosis. , 2014, Neurosurgical focus.

[7]  Z. Gokaslan,et al.  Minimally invasive spine surgery for adult degenerative lumbar scoliosis. , 2014, Neurosurgical focus.

[8]  Juan S. Uribe,et al.  Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study. , 2014, Journal of neurosurgery. Spine.

[9]  R. Fessler,et al.  Lateral transpsoas lumbar interbody fusion: outcomes and deformity correction. , 2014, Neurosurgery clinics of North America.

[10]  M. Dekutoski,et al.  Sagittal Balance and Spinopelvic Parameters After Lateral Lumbar Interbody Fusion for Degenerative Scoliosis: A Case-Control Study , 2014, Spine.

[11]  Adam S. Kanter,et al.  Complex regional pain syndrome following lateral lumbar interbody fusion , 2013 .

[12]  Tien V. Le,et al.  Anterior longitudinal ligament release using the minimally invasive lateral retroperitoneal transpsoas approach: a cadaveric feasibility study and report of 4 clinical cases. , 2012, Journal of neurosurgery. Spine.

[13]  Zachary A. Dooley,et al.  Biomechanics of Lateral Interbody Spacers: Going Wider for Going Stiffer , 2012, TheScientificWorldJournal.

[14]  L. Pimenta,et al.  Results and complications after 2-level axial lumbar interbody fusion with a minimum 2-year follow-up. , 2012, Journal of Neurosurgery : Spine.

[15]  J. Mac-Thiong,et al.  Complications and Morbidities of Mini-open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lumbar Interbody Fusion in 179 Patients , 2012, Asian spine journal.

[16]  K. Ha,et al.  Risk of progression of degenerative lumbar scoliosis. , 2011, Journal of neurosurgery. Spine.

[17]  M. Perez-Cruet,et al.  Complication management with minimally invasive spine procedures. , 2011, Neurosurgical focus.

[18]  Michael Y. Wang,et al.  An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion. , 2011, Journal of neurosurgery. Spine.

[19]  R. Fessler,et al.  Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study. , 2011, Journal of neurosurgery. Spine.

[20]  S. Jatana,et al.  Prospective Analysis of Imaging Prediction of Pseudarthrosis After Anterior Cervical Discectomy and Fusion: Computed Tomography Versus Flexion-Extension Motion Analysis With Intraoperative Correlation , 2011, Spine.

[21]  Edward J. Gerber,et al.  Intraoperative and Early Postoperative Complications in Extreme Lateral Interbody Fusion: An Analysis of 600 Cases , 2011, Spine.

[22]  F. Phillips,et al.  A Prospective, Nonrandomized, Multicenter Evaluation of Extreme Lateral Interbody Fusion for the Treatment of Adult Degenerative Scoliosis: Perioperative Outcomes and Complications , 2010, Spine.

[23]  A. Eckardt,et al.  Less Invasive Surgical Correction of Adult Degenerative Scoliosis. Part II: Complications and Clinical Outcome , 2010, Neurosurgery.

[24]  Hildegard Dohmen,et al.  Less Invasive Surgical Correction of Adult Degenerative Scoliosis, Part I: Technique and Radiographic Results , 2010, Neurosurgery.

[25]  Juan S. Uribe,et al.  Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. , 2010, Neurosurgical focus.

[26]  Adam S. Kanter,et al.  Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. , 2010, Neurosurgical focus.

[27]  L. Lenke,et al.  Adult degenerative scoliosis: evaluation and management. , 2010, Neurosurgical focus.

[28]  Khoi D. Than,et al.  Outcomes after surgery for cervical spine deformity: review of the literature. , 2010, Neurosurgical focus.

[29]  Michael Y. Wang,et al.  Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes. , 2010, Neurosurgical focus.

[30]  N. Anand,et al.  Minimally Invasive Multilevel Percutaneous Correction and Fusion for Adult Lumbar Degenerative Scoliosis: A Technique and Feasibility Study , 2008, Journal of spinal disorders & techniques.

[31]  Andrew P. White,et al.  ADULT DEGENERATIVE SCOLIOSIS: A REVIEW , 2008, Neurosurgery.

[32]  J. Buchowski,et al.  Anterior Cervical Fusion Assessment: Surgical Exploration Versus Radiographic Evaluation , 2008, Spine.

[33]  R. Lin,et al.  Mini-open anterior spine surgery for anterior lumbar diseases , 2008, European Spine Journal.

[34]  Yung Park,et al.  Comparison of One-Level Posterior Lumbar Interbody Fusion Performed With a Minimally Invasive Approach or a Traditional Open Approach , 2007, Spine.

[35]  K. Bridwell.  Decision Making Regarding Smith-Petersen vs. Pedicle Subtraction Osteotomy vs. Vertebral Column Resection for Spinal Deformity , 2006, Spine.

[36]  H. Aryan,et al.  Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. , 2006, The spine journal : official journal of the North American Spine Society.

[37]  L. Lenke,et al.  Comparison of Smith-Petersen Versus Pedicle Subtraction Osteotomy for the Correction of Fixed Sagittal Imbalance , 2005, Spine.

[38]  William Horton,et al.  Correlation of Radiographic Parameters and Clinical Symptoms in Adult Scoliosis , 2005, Spine.

[39]  R. Fraser,et al.  Radiologic Assessment of Interbody Fusion Using Carbon Fiber Cages , 2003, Spine.

[40]  L. Lenke,et al.  Pedicle Subtraction Osteotomy for the Treatment of Fixed Sagittal Imbalance , 2003, The Journal of bone and joint surgery. American volume.

[41]  F. Schwab,et al.  Adult Scoliosis: A Quantitative Radiographic and Clinical Analysis , 2002, Spine.

[42]  L. Lenke,et al.  Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). , 1999, Spine.

[43]  Mayer Hm.  A new microsurgical technique for minimally invasive anterior lumbar interbody fusion , 1997 .

[44]  G. Ehni,et al.  Degenerative Lumbar Scoliosis , 1979, Spine.