title: Combined anterior lumbar interbody fusion and instrumented posterolateral fusion for degenerative lumbar scoliosis: indication and surgical outcomes.
abstract: BACKGROUND
  Traditional approaches to deformity correction of degenerative lumbar scoliosis include anterior-posterior approaches and posterior-only approaches. Most patients are treated with posterior-only approaches because the high complication rate of anterior approach. Our purpose is to compare and assess outcomes of combined anterior lumbar interbody fusion and instrumented posterolateral fusion with posterior alone approach for degenerative lumbar scoliosis with spinal stenosis.
  
  
  METHODS
  Between November 2002 and November 2011, a total of 110 patients with degenerative spinal deformity and curves measuring over 30° were included. Of the 110 patients who underwent surgery, 56 underwent the combined anterior and posterior approach and 54 underwent posterior surgery at our institution. The following were the indications of anterior lumbar interbody fusion: (1) rigid or frank lumbar kyphosis, (2) anterior or lateral bridged traction osteophytes, (3) gross coronal and sagittal deformity or imbalance, and (4) severe disc space narrowing that is not identifiable when performing posterior or transforaminal lumbar interbody fusion. The clinical outcomes were evaluated using the Oswestry disability index and the visual analog scale. The status of fusion were assessed according to the radiographic findings.
  
  
  RESULTS
  All patients received clinical and radiographic follow-up for a minimum of 24 months, with an average follow-up of 53 months (range, 26-96 months). At the final follow-up, the mean ODI score improved from 28.8 to 6.4, and the mean back/leg VAS, from 8.2/5.5 to 2.1/0.9 in AP group and the mean ODI score improved from 29.1 to 6.2, and the mean back/leg VAS, from 9.0/6.5 to 2.3/0.5 in P group. The mean scoliotic angle changed from 41.3° preoperatively to 9.3°, and the lumbar lordotic angle, from 3.1° preoperatively to 35.7° in AP group and the mean scoliotic angle from 38.5 to 21.4 and the lumbar lordotic angle from 6 to 15.8 in P group. There were significant differences in sagittal (P = 0.009) and coronal (P = 0.02) plane correction between the two groups.
  
  
  CONCLUSIONS
  Our results demonstrate that combined anterior lumbar interbody fusion and instrumented posterolateral fusion for adult degenerative lumbar scoliosis effectively improves sagittal and coronal plane alignment than posterior group and both group were effectively improves clinical scores.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin Street, Kweishan Shiang, Taoyuan, 333, Taiwan.
authors.forename: Ming-Kai
authors.initials: MK
authors.lastname: Hsieh
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin Street, Kweishan Shiang, Taoyuan, 333, Taiwan.
authors.forename: Lih-Huei
authors.initials: LH
authors.lastname: Chen
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin Street, Kweishan Shiang, Taoyuan, 333, Taiwan.
authors.forename: Chi-Chien
authors.initials: CC
authors.lastname: Niu
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin Street, Kweishan Shiang, Taoyuan, 333, Taiwan.
authors.forename: Tsai-Sheng
authors.initials: TS
authors.lastname: Fu
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin Street, Kweishan Shiang, Taoyuan, 333, Taiwan.
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lai
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin Street, Kweishan Shiang, Taoyuan, 333, Taiwan. chenwenj@adm.cgmh.org.tw.
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome