Extreme lateral interbody fusion for the treatment of adult degenerative scoliosis |
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| Affiliation: | 1. Department of Orthopaedic Surgery, Duke University Medical Center, Box 2807, 335 Baker House, 200 Trent Drive, Durham, NC 27710, USA;2. Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA;1. Department of Neurology, Tokyo Teishin Hospital, 2-14-23, Fujimi, Chiyoda-ku, Tokyo 102-8798, Japan;2. Department of Dermatology, Tokyo Teishin Hospital, Chiyoda-ku, Tokyo, Japan;3. Department of Neurology, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan;4. Third Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan;1. Department of Neurosurgery, University Medical Center Langendreer, Ruhr-University-Bochum, In der Schornau 23-25, D-44892 Bochum, Germany;2. Department of Radiology and Neuroradiology, University Medical Center Langendreer, Ruhr-University-Bochum, D-44892 Bochum, Germany;1. Department of Orthopaedic Surgery, Duke University Medical Center, Post Office Box 3000, Durham, NC 27710, USA;2. Division of Neurological Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA;1. Department of Orthopedic Surgery, Keio University School of Medicine, Japan;2. Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Japan;3. Department of Orthopedic Surgery, Fujita Health University, Japan;4. Keio Spine Research Group (KSRG), Japan;1. Cyclotron Institute, Texas A&M University, College Station, TX 77843, USA;2. Department of Chemistry, Texas A&M University, College Station, TX 77843, USA;3. Laboratori Nazionali del Sud-INFN, via Santa Sofia 62, 95123 Catania, Italy;4. National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, MI 48824, USA;5. Department of Chemistry, Michigan State University, East Lansing, MI 48824, USA;6. Department of Physics, Texas A&M University, College Station, TX 77843, USA |
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| Abstract: | ![]()
Extreme lateral interbody fusion (XLIF; NuVasive Inc., San Diego, CA, USA) is a minimally invasive lateral transpsoas approach to the thoracolumbar spine. Though the procedure is rapidly increasing in popularity, limited data is available regarding its use in deformity surgery. We aimed to evaluate radiographic correction using XLIF in adults with degenerative lumbar scoliosis. Thirty consecutive patients were followed for an average of 14.3 months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Plain radiographs were obtained on all patients preoperatively, postoperatively, and at most recent follow-up. Plain radiographic measurements of coronal Cobb angle, apical vertebral translation, segmental lordosis, global lordosis, disc height, neuroforaminal height and neuroforaminal width were made at each time point. CT scans were obtained for all patients 1 year after surgery to evaluate for fusion. There was significant improvement in multiple radiographic parameters from preoperative to postoperative. Cobb angle corrected 72.3%, apical vertebral translation corrected 59.7%, neuroforaminal height increased 80.3%, neuroforaminal width increased 7.4%, and disc height increased 116.7%. Segmental lordosis at L4–L5 increased 14.1% and global lordosis increased 11.5%. There was no significant loss of correction from postoperative to most recent follow-up. There was an 11.8% pseudoarthrosis rate at levels treated with XLIF. Complications included lateral incisional hernia (n = 1), rupture of anterior longitudinal ligament (n = 2), wound breakdown (n = 2), cardiac instability (n = 1), pedicle fracture (n = 1), and nonunion requiring revision (n = 1). XLIF significantly improves coronal plane deformity in patients with adult degenerative scoliosis. XLIF has the ability to correct sagittal plane deformity, although it is most effective at lower lumbar levels. |
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