Short-term clinical analysis of lumbar lateral anterior interbody fusion in the treatment of degenerative lumbar scoliosis / 中华骨科杂志

ABSTRACT

Objective:To investigate the feasibility and early clinical effect of lumbar lateral anterior interbody fusion in the treatment of degenerative lumbar scoliosis.Methods:Forty patients with degenerative lumbar scoliosis who underwent lumbar lateral anterior interbody fusion combined with posterior percutaneous pedicle screw and rod internal fixation from January 2018 to January 2020 were selected. There were 17 males and 23 females; The age was 65.4±7.2 years (range 51-84 years). All patients had obvious low back pain, of which 22 patients (55.0%) had lower limb pain, numbness or intermittent claudication. 16 patients (40.0%) had scoliosis and the main curve protruded to the right, and 24 patients (60.0%) had scoliosis and the main curve protruded to the left. The operation time and intraoperative bleeding were recorded. The main outcome measures were visual analogue scale (VAS), Oswestry disability index (ODI), the MOS item short from health survey (SF-36), deformity correction, bone graft fusion time and complications.Results:The left approach was used in 16 cases of scoliosis with the main curve protruding to the right; In 24 cases, the main curve of scoliosis protruded to the left, of which 6 cases showed osteophyte on the concave side (right side) of coronal CT and the right approach was adopted, while the rest were adopted the left approach. Single segment fusion was performed in 8 cases (20.0%), double segment fusion in 12 cases (30.0%), three segment fusion in 16 cases (40.0%), and four segment fusion in 4 cases (10%). Among the 22 patients with symptoms of lower limb nerve damage, 6 needed secondary unilateral laminectomy. All 40 patients completed the operation successfully, the operation time was 255±37 min (range 130-345 min) and the amount of intraoperative bleeding was 100±16.2 ml (range 10-505 ml). All patients were followed up for 12.8±4.5 months (range 6-24 months). The preoperative VAS score was 5.7±1.0, improved to 3.5±0.7 on the first day after operation, and 1.4±0.3 at the last follow-up. The difference was statistically significant ( F=2322.229, P <0.001). The preoperative ODI was 79.9%±9.3%, the first day after operation was 51.6%±8.9%, and the last follow-up was 11.7%±2.2%. The difference was statistically significant ( F=3770.411, P <0.001). SF-36 was 68.6±5.3 before operation and 78.4±5.5 on the first day after operation, which increased to 109.9 ± 4.9 at the last follow-up. The difference was statistically significant ( F=21736.486, P <0.001). The Cobb angle of lumbar scoliosis was 27.8°±14.1° before operation and 7.5°±3.5° on the first day after operation, the difference was statistically significant ( t=3.551, P <0.001); The height of intervertebral space was 10.9±2.1 mm before operation and 15.3±3.4 mm on the first day after operation, the difference was statistically significant ( t=2.106, P <0.001). 24 patients (60.0%) had pain or numbness in the front of the thigh, and 4 patients (10.0%) had quadriceps femoris weakness; These symptoms disappeared within 3 months after operation in 26 patients, except that the numbness in the front of the thigh was only reduced in 2 patients 3 months after operation. All patients achieved satisfactory fusion in all segments at the last follow-up, and there was no non-fusion. Conclusion:Lumbar lateral anterior interbody fusion is a safe and feasible method for the treatment of degenerative lumbar scoliosis.