Zhonghua yi xue za zhi · 2013
[Treatment of degenerative lumbar scoliosis with selective segmental transforaminal lumbar interbody fusion].
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Wang Lei, Liu Chao, Zhao Qing-hua, Tian Ji-wei
Аннотация
OBJECTIVE: To explore the treatment outcomes of degenerative lumbar scoliosis (DLS) with selective segmental transforaminal lumbar interbody fusion (TLIF).
METHODS: The clinical data were analyzed for a total of 42 cases with degenerative scoliosis from November 2008 to March 2011.There were 14 males and 28 females with a mean age of 62.4 years (range, 41-76).The indications for TLIF of motion segment included segmental instability and significant upper endplate obliquities of L3 or L4.Interbody spinal fusion was performed for 3 segments in 3 cases; 2 in 17; 1 in 22.All patients were followed postoperatively with a mean duration of 1.6 years (range, 0.5-3).The imaging examinations included Cobb angle of scoliosis and lumbar lordosis angle.The clinical symptoms were evaluated with Oswestry disability index (ODI) score.
RESULTS: The mean preoperative Cobb angle of 32.7° ± 12.4° was significantly corrected to 9.2° ± 5.5° at the final follow-up (t = 14.86, P < 0.05) with a correction rate of 71.8%. The mean preoperative lumbar lordosis angle of 25.5° ± 12.6° was also significantly corrected to 39.3° ± 8.5° (t = 12.11, P < 0.05) with a correction rate of 46.4%.There was significant difference (P < 0.05) in ODI between preoperation (43.8 ± 5.6) and postoperation (18.7 ± 1.8).But no significant difference (P > 0.05) existed in ODI between postoperation (18.7 ± 1.8) and the final follow-up (23.6 ± 2.3). And 86% of the patients showed considerable symptomatic improvement of neurogenic intermittent claudication. And clinical symptoms and functional tolerance for daily activities improved postoperatively in 92%. At the follow-up after 6 months postoperatively, all operated segments achieved fusion standard and no pseudoarthrosis formed.
CONCLUSION: Selective segmental TLIF is helpful in correcting lumbar lordosis, segmental deformity and translation. And it offers better outcomes of posterior spinal fusion for the treatment of DLS.
METHODS: The clinical data were analyzed for a total of 42 cases with degenerative scoliosis from November 2008 to March 2011.There were 14 males and 28 females with a mean age of 62.4 years (range, 41-76).The indications for TLIF of motion segment included segmental instability and significant upper endplate obliquities of L3 or L4.Interbody spinal fusion was performed for 3 segments in 3 cases; 2 in 17; 1 in 22.All patients were followed postoperatively with a mean duration of 1.6 years (range, 0.5-3).The imaging examinations included Cobb angle of scoliosis and lumbar lordosis angle.The clinical symptoms were evaluated with Oswestry disability index (ODI) score.
RESULTS: The mean preoperative Cobb angle of 32.7° ± 12.4° was significantly corrected to 9.2° ± 5.5° at the final follow-up (t = 14.86, P < 0.05) with a correction rate of 71.8%. The mean preoperative lumbar lordosis angle of 25.5° ± 12.6° was also significantly corrected to 39.3° ± 8.5° (t = 12.11, P < 0.05) with a correction rate of 46.4%.There was significant difference (P < 0.05) in ODI between preoperation (43.8 ± 5.6) and postoperation (18.7 ± 1.8).But no significant difference (P > 0.05) existed in ODI between postoperation (18.7 ± 1.8) and the final follow-up (23.6 ± 2.3). And 86% of the patients showed considerable symptomatic improvement of neurogenic intermittent claudication. And clinical symptoms and functional tolerance for daily activities improved postoperatively in 92%. At the follow-up after 6 months postoperatively, all operated segments achieved fusion standard and no pseudoarthrosis formed.
CONCLUSION: Selective segmental TLIF is helpful in correcting lumbar lordosis, segmental deformity and translation. And it offers better outcomes of posterior spinal fusion for the treatment of DLS.