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DEGENERATIVE LUMBAR SCOLIOSIS TREATED WITH POSTERIOR FUSION WITH TLIF OR ALIF: COMPLICATIONS, CLINICAL AND RADIOGRAPHIC OUTCOMES

Is anterior-posterior fusion required for optimal surgical outcomes in Degenerative Lumbar Scoliosis(DLS)? We studied a series of DLS patients surgically treated to determine the need for anterior surgery. Methods:Forty-three consecutive patients with DLS age 68years(47–85years) underwent posterior instrumented reduction/fusion by one surgeon. Interbody fusion with cages was transforaminal(TLIF)in 23 patients at average 2.7levels(1–4levels), and anterior(ALIF)in 20 at average 4.2levels(3–6levels). Two in ALIF group required osteotomies to release ankylosed segments. BMP-2 was used at 2–8mg/disk space for each interbody fusion. Posterior constructs averaged 6.8levels(4– 9levels) for both groups. Clinical (Oswestry, visual analog pain scores (VAS), pain medication use), and radiographic (standing AP, lateral, Flexion/Extension x-rays)follow-up averaged 38months(24–68 months). Results:The ALIF group had more complications, with 2nonunions, 2adjacent level fractures, 2revisions for adjacent level degeneration, 2infections, and 1footdrop. Medical complications in this group included 1each pulmonary embolus, ileus requiring colostomy, and stroke. The TLIF group had 1 each infection, nonunion, transient footdrop, and additional surgery to adjust coronal balance. VAS were similar: TLIF 6.7pre-op(3–10) improved to 2.9(1–8), and ALIF 6.5pre-op(0–10) improved to 2.9(1–7). Pain medication usage was similar in both groups. Oswestry outcomes were similar: TLIF 46.9(18–66) pre-op improved to 25.5(18–36), and ALIF 52.0(28–82) improved to 31.0(0–64). Direct vertebral translation was used to correct coronal and sagittal deformity in all patients. Curve correction was similar, with ALIF group curves of 34°(13–49°) pre-op correcting 70% to 10°(0–18°). TLIF group curves of 27°(14–64°) pre-op corrected 70% to 8°(0–22°). Conclusions:With current deformity correction techniques, TLIF, and BMP-2, similar deformity correction and fusion rates can be achieved with a posterior-only approach as compared with combined anterior-posterior surgery. However, the complications with posterior-only surgery for DLS in this age group with their inherent co-morbidities appear to be significantly fewer. These findings suggest anterior surgery is rarely indicated for DLS. I N T E R N A T I O N A L S O C I E T Y F O R T H E S T U D Y O F L U M B A R S P I N E