Instrumented posterior lumbar interbody fusion for patients with degenerative lumbar scoliosis.
OBJECTIVE
Surgery for degenerative lumbar scoliosis remains challenging for spine surgeons even with the application of pedicle screw instrumentation. This retrospective study assesses the outcomes of instrumented posterior lumbar interbody fusion (PLIF) for degenerative lumbar scoliosis.


METHODS
From April 2000 to April 2004, 26 patients with degenerative lumbar scoliosis were treated with instrumented PLIF. Mean age of the 15 females and 11 males was 64.2 years (range, 51 to 77 y). Clinical and radiographic outcomes were retrospectively reviewed for each case at a minimum follow-up of 2 years (median follow-up, 3 y; range, 2 to 6 y). At final follow-up, patients were classified as "satisfied" or "dissatisfied" according to self-reported outcomes.


RESULTS
At most recent follow-up, the average Oswestry Disability Index score was significantly lower than the preoperative score (25.8 vs. 58.0; P<0.001). Twenty (76.9%) patients reported that they were satisfied with their surgical outcomes. The average lumbar scoliosis angles were significantly less than preoperative angles (7.4 vs. 16.5 degrees; P<0.001), resulting in a reduction in mean scoliosis angles of 55.2%. The average angles of lumbar lordosis were significantly higher than preoperative angles (30.1 vs. 22.2 degrees; P=0.001), an increase in mean lumbar lordosis angles of 35.6%. No perioperative deaths or major medical complications occurred. Five patients had adjacent segment degeneration and 4 (80%) of 5 reported dissatisfactory outcomes. Further study is required to identify the etiologies of adjacent segment degeneration and methods for avoiding such degeneration.


CONCLUSIONS
Analytical results demonstrate that instrumented PLIF after laminectomy in patients with degenerative lumbar scoliosis is an effective and safe procedure.
Wu
Chin-Hsien
CH
Department of Orthopaedics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan.
Wong
Chak-Bor
CB
Chen
Lih-Huei
LH
Niu
Chi-Chien
CC
Tsai
Tung-Ting
TT
Chen
Wen-Jer
WJ
D000368:Aged; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007796:Laminectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome