title: A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications.
abstract: METHODS
  Prospective multicenter nonrandomized institutional review board-approved observational study of clinical and radiographic outcomes of the extreme lateral interbody fusion (XLIF) procedure in adult scoliosis.
  
  
  OBJECTIVE
  Perioperative measures from this longitudinal study were compiled to identify the short-term results and complications of the procedure.
  
  
  BACKGROUND
  The surgical treatment of adult scoliosis presents a treatment challenge. Neural decompression with combined anterior/posterior instrumented fusion is often performed. These procedures have been reported to carry a high risk of complication, particularly in the elderly patient population. Over the past decade, less invasive surgical approaches to neural decompression and fusion have been popularized and have recently been applied in the treatment of degenerative scoliosis. To date, there has been little published data evaluating these treatment approaches.
  
  
  METHODS
  A total of 107 patients who underwent the XLIF procedure with or without supplemental posterior fusion for the treatment of degenerative scoliosis were prospectively studied. Intraoperative data collection included surgical procedural details, operative time, estimated blood loss, and surgical complications. Postoperative complications, length of hospital stay, and neurologic status were recorded. For this report, perioperative data (inclusive of outcomes through the 6-week postoperative clinic visit) were evaluated.
  
  
  RESULTS
  In all, 107 patients (mean age, 68 years; range, 45-87) were treated with XLIF; 28% had at least 1 comorbidity. A mean of 4.4 levels (range, 1-9) were treated per patient. Supplemental pedicle screw fixation was used in 75.7% of patients, 5.6% had lateral fixation, and 18.7% had stand-alone XLIF. Mean operative time and blood loss were 178 minutes (58 minutes/level) and 50 to 100 mL. Mean hospital stay was 2.9 days (unstaged), 8.1 day (staged, 16.5%), 3.8 days overall. Five patients (4.7%) received a transfusion, 3 (2.8%) required intensive care unit admission, and 1 (0.9%) required rehabilitation services. Major complications occurred in 13 patients (12.1%): 2 (1.9%) medical, 12 (11.2%) surgical. Of procedures that involved only less invasive techniques (XLIF stand-alone or with percutaneous instrumentation), 9.0% had one or more major complications. In those with supplemental open posterior instrumentation, 20.7% had one or more major complication. Early reoperations (3) (all for deep wound infections) were associated with open posterior instrumentation procedures.
  
  
  CONCLUSIONS
  The morbidity in adult scoliosis surgery is minimized with less invasive techniques. The rate of major complications in this study (12.1%) compares favorably to that reported from other studies of surgery for degenerative deformity.
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA. robert.isaacs@duke.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Isaacs
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hyde
authors.forename: J Allan
authors.initials: JA
authors.lastname: Goodrich
authors.forename: William Blake
authors.initials: WB
authors.lastname: Rodgers
authors.forename: Frank M
authors.initials: FM
authors.lastname: Phillips
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome