Selective Segmental TLIF For Degenerative Lumbar Scoliosis

Objective: With the advent of an aging society, The problem ofdegenerative diseases is getting worse. And the namber of which patients withdegenerative lumbar scoliosis proportion is also increasing. Due todegeneration of the intervertebral disc and facet joints, spinal canal andintervertebral foramen stenosis, lumbar scoliosis deformity, witch causesdisturbing back pain, radicular symptoms and lowers the quality of life.Although properly selected patients are likely to benefit from surgery, mostpatients prefer conservative approaches comprising of physiotherapy,acupuncture and lifestyle modifications.With the socio-economic developmentand ideological change in patients in recent years,an increasing number ofdegenerative lumbar scoliosis patients selected by surgical treatment afterconservative treatment fails.The Pathogenesis of degenerative lumbar scoliosisis complex, diverse, and no definite conclusion.Therefore,there is muchcontroversy in the choice of surgical approach,decompression range andFusion methods at present.The study of the efficacy with transforaminallumbar interbody fusion selective decompression treatment degenerativelumbar scoliosis,The aim is to provide relevant theoretical basis for thesurgical treatment of degenerative lumbar scoliosis.Methods:A retrospective analysis of the information,which patients withdegenerative lumbar scoliosis by transforaminal lumbar interbody fusionselective decompression in our hospital form March2009to October2011.there are54cases(23males，31females) met the inclusioncriteria,including; the average age of patients was65.2years (range:55to71y).Patients were taken Plain radiographs of the standing spine,anteroposteriorand lateral views, flexion/extension views, and bending views.And the CTand MRI to determine the stenosis location and degree of lumbarspine.Patients were excluded if they had a fixed and fusion of spinal surgery.TLIF with intervertebral cage was then carried out in the segments,which met one or more of the following criteria：①by imaging and rigorousclinical examination to determine the cause of lower limb neurologicalsymptoms in this ntervertebral space；②vertebral translation in coronalplane>3mm;③segmental instability (sagittal translation>3mm or sagittalrotation>15degrees);④(bilateral facetectomy>50%or unilateral totalfacetectomy in intraoperative;⑤fusion to the sacrum.In this study, posteriorinstrumented spinal fusion was carried out in6segments in4cases,5segments in4cases,4segments in7cases,3segments in13cases,2segmentsin18cases, and1segment in8cases.TLIF with intervertebral cage wascarried out in3segments in2cases,2segments in23cases, and1segment in29cases.The clinical outcomes were assessed by pre-and post-operativeJapanese Orthopedic Association score and patient satisfactionindex.Radiographic evaluation included Cobb angle of scoliosis,lumbarlordosis angle,segmental lordosis angle and intervertebral height.Statistical analysis was performed with SPSS13.0.Data before andsurgery were processed with a paired Student’s t-test.The relationship betweenthe result of radiographic study and clinical outcome was analyzed withPearson correlation analysis. Data are expressed as mean±standarddeviation(Statistical significance was assumed for P values <0.05in allcases).Results：Two patients with CSF leakage，using the methods of wounddressing of pressure and raise thebeds of the foot side to cure. Two Patientswith urinary tract infection cases, use of sensitive antibiotic anti-infectivetherapy are cure after one week.All of the54patients were followed up,theaverage follow-up period was of1.8years (range:1to2.5y).The Cobb angleof lumbar scoliosis before surgery with an average of30.7±13.6degrees.Atthe final follow-up Cobb angle with an average of11.2±6.8degrees, whichwas significantly improve than that of the preoperative condition(t=14.522,P<0.05),and the correction rate was66.4%.The average of lumbar lordosisangle before surgery was-29.5±11.6degrees.At the last follow-up lumbar lordosis angle with an average of-38.6±8.7degrees, which was significantlyhigher than before surgery (t=12.295,P<0.05), The correction rate aftersurgery was30.8%.The angle of the TLIF segment before surgery was6.5±6.8degrees. At the last follow-up the angle of the TLIF segment was10.6±5.7degrees， which was significantly higher than before surgery(t=13.251,P<0.05).The angle of the TLIF segment was increased by nearly3.5degreesper segment. The correction rate was56%.Preoperative disk height averaged6.1±4.5mm.At the last follow-up disk height averaged9.8±4.3mm,which wassignificantly higher than before surgery (t=10.025,P<0.05),The correction rateafter surgery was60%.The average JOA score was significantly improvedfrom13.1±4.2before surgery to24.3±5.8at the last follow-upSurvey(t=11.545, P<0.05).Lumbar lordosis angle was increased3to35degrees after surgery. JOA score was increased2to17. There was a positivecorrelation between the increase of lumbar lordosis angle and the increase ofJOA score（r=0.613,P=0.016).By the85%of patients would accept thissurgery again for the same result.At the last follow-up98%of TLIF segmenthad achieved spinal fusion.Conclusion:Selective segmental TLIF is selectively used to treat theDegenerative Lumbar Scoliosis the radiographic and clinical results weresatisfactory.