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Abstract
Study Design
In this study, 18 patients undergoing posterior lumbar interbody fusion for multilevel lumbar spinal stenosis associated with degenerative scoliosis were reviewed retrospectively.
Objectives
To assess the effectiveness of the cage- instrumented posterior lumbar interbody fusion in multilevel lumbar spinal stenosis associated with degenerative scoliosis.
Summary of literature Review
Degenerative lumbar scoliosis with the problems of neurogenic claudication, mechanical back pain and spinal deformity present a challenge for treatment.
Materials and Methods
We reviewed 18 surgical cases of multilevel lumbar spinal stenosis with degenerative scoliosis from March 1995 to A pril 2000 with an average follow up period of 2.9 years. We assessed the radiographic results of scoliotic angle correction and sagittal angle correction of the maximum curve and fused segment and disc height restoration. Clinical results were evaluated according to the Kirkaldy-Willis criteria.
Results
Mean scoliotic angle at preoperative, postoperative and final followup (maximum curve/fused segment) was 17.7- 6.1-7.3。 /15.0- 5.8- 6.1 。 respectively. Mean sagittal angle corresponding to each period was 12.1- 34.1- 32.7。 /8.3- 27.0- 26.0。 respectively. Mean disc height corresponding to each period was 22.9- 42.4- 40.5% respectively. The clinical result was analyzed as 15 satisfactory (83.3%), 3 fair (16.7%) and no poor. Fusion success was achieved in all patients. There were no serious complications except one case of fusion extension distally and no significant curve progression within followup period.
Conclusions
The cage- posterior lumbar interbody fusion in multilevel lumbar spinal stenosis with degenerative scoliosis was effective for correction of scoliotic and sagittal deformity and restoration of disc height with resultant foraminal patency, provided relatively high clinical success and in situ fusion success in all cases even over multiple fusion levels, and can be an alternative among surgical treatments of this complex disease.
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Figures and Tables%
Fig. 1.
A 70-year-old male with left 24˚ T12-L4 degenerative scoliosis. AP & lateral radiographs show prominent degenerative change and disc space narrowing of the whole lumbar spine with a loss of lumbar lordosis (A). Postoperative radiographs after multilevel cage-PLIF show good restoration of scoliotic angle, lumbar lordosis, disc height and foraminal patency (B). The 2.1-year followup examination shows only a slight loss of correction, but shows a significant decrease of L5-S1 disc height resulting in vacuum disc phenomenon and marked symptomatic narrowing of the intervertebral foramen (C). At 3-year followup period, a distal fusion extension with cage-PLIF was performed (D). Followup radiographs show maintenance of correction and consolidated PLIF graft, and show broken screw fragment (black arrow) (E).
Table 1.
Radiographic findings
Table 2.
Scoliotic angle correction
| Pre-Op | Post-Op | Last F/U | |
|---|---|---|---|
| Mean ScA∗ (Global) | 17.7˚ | 6.1˚ | 7.3˚ |
| Mean ScA∗ (Fused) | 15.0˚ | 5.8˚ | 6.1˚ |
| ScAC† Gain (Global) | (11.6˚) | ||
| ScAC† Gain (Fused) | (9.2˚) | ||
| ScAC Loss (Global) | (1.2˚) | ||
| ScAC Loss (Fused) | (0.3˚) | ||
Table 3.
Sagittal angle correction
| Pre-Op | Post-Op | Last F/U | |
|---|---|---|---|
| Mean SaA∗ (Global) | 12.1˚ | 34.1˚ | 32.7˚ |
| Mean SaA∗ (Fused) | 08.3˚ | 27.0˚ | 26.0˚ |
| SaAC† Gain (Global) | (22.0˚) | ||
| SaAC† Gain (Fused) | (18.7˚) | ||
| SaAC Loss (Global) | (1.4 | 4˚) | |
| SaAC Loss (Fused) | (1.0 | 0˚) | |
Table 4.
Disc height restoration
| Pre-Op | Post-Op | Last F/U | |
|---|---|---|---|
| Mean DHR∗ | 22.9% | 42.4% | 40.5% |
| DHR Gain | (19.5%) | ||
| DHR Loss | (1.9%) | ||
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