Clinical study on minimally invasive transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis

Abstract

Objective To discuss the operative essentials and therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis (DLS).  Methods A total of 17 DLS patients without prior spinal diseases were treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University. The operation time, intraoperative blood loss, hospital stay, and postoperative complication were recorded in each patient. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate postoperative improvement of low back and leg pain, and clinical effects were assessed according to Medical Outcome Study 36-Item Short-Form Health Survey (SF-36). Coronal Cobb angle, sagittal lordosis angle and spinal deviation distances on coronal and sagittal plane were measured before operation, one week, 3 months after operation and in the last follow-up in spinal full-length X-ray examination. Fusion rate was calculated according to X-ray or CT scan, and the degree of decompression was evaluated by MRI.  Results Decompression and fusion levels ranged from T₁₂-S₁ vertebrae, and interbody fusion was performed in 17 patients and 56 levels were fused. Average operation time was 200 min (180-300 min), intraoperative blood loss was 320 ml (200-1000 ml) and hospital stay was 8.21 d (5-12 d). All patients were followed-up for 12.13 months (5-24 months). Compared with preoperation, VAS (P = 0.000, for all) and ODI scores (P = 0.000, for all) decreased significantly, SF-36 score increased (P = 0.000, for all), coronal Cobb angle (P = 0.000, for all), sagittal lordosis angle (P = 0.000, for all), coronal and sagittal deviation (P = 0.000, for all) decreased significantly one week and 3 months after operation and in the last follow-up. The improvement rate of ODI was (86.51 ± 6.02)%, fusion rate of vertebral bodies was 89.21%, and the position of screws was good. No neurological defect, infection, or cerebrospinal fluid (CSF) leakage occurred after operation. No pedicle screw or rod breakage or Cage displacements was found. There was no death case. Conclusions MIS-TLIF combined with percutaneous pedicle screw fixation is an effective technique for treatment of DLS patients, with less injury, less intraoperative blood loss, low complication incidence, good scoliosis correction and definite therapeutic effects, even this method needs more operation time and longer learning curve.

DOI: 10.3969/j.issn.1672-6731.2016.04.005