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The effect of MIS-TLIF in the treatment of adult lumbar degenerative scoliosis, a retrospective study

Ruxing Pei, Xuefeng Shi

Background: The patients of Adult Lumbar Degenerative Scoliosis (ALDS) are commonly complicated with advanced age, osteoporosis, cardiopulmonary insufficiency, and some other medical comorbidity. Due to the feature of such cases, the traditional open surgery can lead to high rate of postoperative complications. The purpose of this study is to introduce our experiences and explore the efficacy and feasibility of Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) in the treatment of patients of ALDS whose symptom is mainly single level radicular pain or neurogenic claudication, without dynamic back pain.

Methods: From January 2008 to January 2013, a retrospective study of 37 patients with ALDS treated with MIS-TLIF was completed with at least 2 year follow-up. Visual Analog Scores (VAS) and Oswestry Disability Index (ODI) were evaluated preoperatively and at the time of 2 y follow-up. Radiographic measurements included the Cobb angle of lumbar curve, Lumbar Lordosis (LL), Sacrum Slope (SS), and Pelvic Tilt (PT). Radiographic evaluation of the fusion integrity was performed at the time of 2 y follow-up.

Results: The mean VAS back pain scores decreased from 4.55 ± 0.9 preoperatively to 2.2 ± 0.8 at 2 y follow-up (P<0.05), and the mean VAS leg pain scores decreased from 8.2 ± 0.6 preoperatively to 0.95 ± 0.8 at 2 y follow-up (P<0.05). The ODI score improved from 60.56 ± 15.1% preoperatively to 23.46 ± 8.2% at 2 y follow-up (P<0.05). The average lumbar curve was 18.7 ± 5.3º. Preoperatively, and 10.3 ± 5.38º at 2 y follow-up (P<0.05). The LL changed from -31.4 ± 12.7º to -37.4 ± 10.1º at 2 y follow-up (P<0.05). Solid fusion was achieved in all patients.

Conclusion: The technique of MIS-TLIF can be used to treat the patients of ALDS whose symptom is mainly single level radicular pain or neurogenic claudicationwithout dynamic back pain, achieving favorable clinical outcomes, good fusion, and satisfactory curve correction with less blood loss and complications.