Long-term clinical outcomes of selective segmental transforaminal lumbar interbody fusion combined with posterior spinal fusion for degenerative lumbar scoliosis

Abstract

Background: The purpose of the current study was to investigate the long-term clinical outcomes of this technique for degenerative scoliosis (DS).

Methods: The records of 95 consecutive patients with DS who underwent selective segmental transforaminal interbody fusion combined with posterior-instrumented spinal fusion in our department from January 1999 to December 2007 were analysed retrospectively. Average follow-up was 7.8 years. Recorded clinical outcomes included Oswestry Disability Index (ODI), visual analogue scale (VAS) pain scores and overall patient satisfaction. Radiographic measurements included coronal Cobb angle, apical vertebra translation, Nash-Moe grade, lumbar lordosis (LL) and thoracolumbar kyphosis. Comparison of the clinical and radiographic parameters before surgery and at final follow-up was studied. Linear correlation analysis was applied to analyse the relationship between the clinical and radiological results.

Results: Average ODI and VAS pain scores were significantly improved at final follow-up compared with baseline (P=0.038; P=0.005). Specifically, the average ODI score was 32.2±8.6 before surgery and 11.1±6.8 at final follow-up; the average VAS score was 8.9±2.0 before surgery and 2.0±1.2 at final follow-up; patient satisfaction was 88.2% (84/95) at final follow-up. In addition, Cobb angle, apical vertebra translation and Nash-Moe grade were all statistically significantly decreased compared with preoperative values (P=0.019; P=0.035; P=0.001). Although LL had significantly increased (P=0.022), thoracolumbar kyphosis did not exhibit a significant change (P=0.64). There was significant correlation between LL and decreased ODI scores (r=0.62, P=0.01). Eleven patients (11.6%) underwent reoperation during the study period.

Conclusion: Selective segmental transforaminal interbody fusion combined with posterior-instrumented spinal fusion appears to have reasonable long-term clinical and radiographic outcomes for the treatment of DS.

Keywords: degenerative scoliosis; interbody fusion; long-term complication; selective segmental transforaminal lumbar interbody fusion (TLIF).