title: Posterior corrective surgery with a multilevel transforaminal lumbar interbody fusion and a rod rotation maneuver for patients with degenerative lumbar kyphoscoliosis.
abstract: The purpose of this study was to assess the clinical results of posterior corrective surgery using a multilevel transforaminal lumbar interbody fusion (TLIF) with a rod rotation (RR) and to evaluate the segmental corrective effect of a TLIF using CT imaging. The medical records of 15 consecutive patients with degenerative lumbar kyphoscoliosis (DLKS) who had undergone posterior spinal corrective surgery using a multilevel TLIF with an RR technique and who had a minimum follow-up of 2 years were retrospectively reviewed. Radiographic parameters were evaluated using plain radiographs, and segmental correction was evaluated using CT imaging. Clinical outcomes were evaluated with the Scoliosis Research Society Patient Questionnaire-22 (SRS-22) and the SF-36. The mean follow-up period was 46.7 months, and the mean age at the time of surgery was 60.7 years. The mean total SRS-22 score was 2.9 before surgery and significantly improved to 4.0 at the latest follow-up. The physical functioning, role functioning (physical), and social functioning subcategories of the SF-36 were generally improved at the latest follow-up, although the changes in these scores were not statistically significant. The bodily pain, vitality, and mental health subcategories were significantly improved at the latest follow-up (p < 0.05). Three complications occurred in 3 patients (20%). The Cobb angle of the lumbar curve was reduced to 20.3° after surgery. The overall correction rate was 66.4%. The pelvic incidence-lumbar lordosis (preoperative/postoperative = 31.5°/4.3°), pelvic tilt (29.2°/18.9°), and sagittal vertical axis (78.3/27.6 mm) were improved after surgery and remained so throughout the follow-up. Computed tomography image analysis suggested that a 1-level TLIF can result in 10.9° of scoliosis correction and 6.8° of lordosis. Posterior corrective surgery using a multilevel TLIF with an RR on patients with DLKS can provide effective correction in the coronal plane but allows only limited sagittal correction.
authors.affiliation: Department of Orthopaedic Surgery, Osaka City General Hospital; and.
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumura
authors.affiliation: Department of Orthopaedic Surgery, Osaka City General Hospital; and.
authors.forename: Takashi
authors.initials: T
authors.lastname: Namikawa
authors.affiliation: Department of Orthopaedic Surgery, Osaka City General Hospital; and.
authors.forename: Minori
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Orthopaedic Surgery, Osaka City General Hospital; and.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Ozaki
authors.affiliation: Department of Orthopaedic Surgery, Osaka City General Hospital; and.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hori
authors.affiliation: Department of Orthopaedic Surgery, Osaka City General Hospital; and.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Hidaka
authors.affiliation: Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging / Q000601:surgery*; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D065289:Pedicle Screws; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: ASD = adult spinal deformity; CVA = coronal vertical axis; DLKS = degenerative lumbar kyphoscoliosis; FBB = fulcrum backward bending; IVR = intervertebral release; L-Cobb angle = Cobb angle of lumbar curve; LIV = lowest instrumented vertebra; LL = lumbar lordosis; MPR = multiplanar reconstruction; PI = pelvic incidence; PO = 1 week after surgery; PT = pelvic tilt; PreO = immediately prior to surgery; RR = rod rotation; SLA = segmental lordotic angle; SRS-22 = Scoliosis Research Society Patient Questionnaire-22; SVA = sagittal vertical axis; SWA = scoliotic wedging angle; T-Cobb angle = Cobb angle of compensatory thoracic curve; TK = thoracic kyphosis; TLIF = transforaminal lumbar interbody fusion; TLK = thoracolumbar kyphosis; UIV = upper instrumented vertebra; degenerative lumbar kyphoscoliosis; multilevel transforaminal lumbar interbody fusion; rod rotation maneuver; surgical outcomes