Mid-long-term clinical research of staged minimally invasive surgery in the treatment of severe adult degenerative scoliosis

ObjectiveTo evaluate the clinical efficacy of staged minimally invasive surgery in restoring coronal and sagittal balance in adult patients with severe degenerative scoliosis(SDS).

MethodsThe clinical data of 20 adult SDS patients treated with staged surgery were retrospectively analyzed.The operative time, intraoperative blood loss and perioperative complications were recorded.The parameters of coronal plane, sagittal plane and pelvis at standing position before and after operation were evaluated using EOS imaging system.All patients were followed up for 3 to 5 years.The parameters in all cases between before and after operation were compared.

ResultsThe operative time and intraoperative blood loss were(231±48)min and(253±80)mL in one-stage lumbar interbody fusion via lateral approach, respectively.The operative time and intraoperative blood loss were (155±33)min and(326±99)mL in two-stage percutaneous pedicle screw fixation, respectively.The interval between two operations was 7 to 42 d.The imaging parameters were significantly improved after one-stage lumbar interbody fusion via lateral approach, and the parameters were further improved after two-stage minimally invasive posterior fixation.On the coronal plane, the Cobb angle decreased from(43.1±7.3)° to (11.4±4.0)° after one-stage operation(P < 0.01), and(5.5±1.9)° after two-stage operation(P < 0.01).On the sagittal plane, the lumbar lordosis angle increased from(16.8±8.4)° to(30.2±6.8)° after one-stage operation(P < 0.01), and was restored to(37.1±4.0)åfter two-stage operation(P < 0.01).The vertical axis of sagittal plane decreased from(10.5±2.4)cm to (5.3±2.1)cm after one-stage operation(P < 0.01), and decreased to(3.1±1.5)cm after two-stage operation(P < 0.01).In terms of pelvic parameters, the matching degree of pelvic projection angle and lumbar lordosis angle decreased from(33.6±9.6)° to (7.8±4.5)åfter one-stage operation(P < 0.01) and(9.9±3.7)° after two-stage operation(P < 0.01).The visual analogue score and scores of low back pain, leg pain and Oswestry dysfunction index during following-up were significantly improved compared with before treatment(P < 0.01).

ConclusionsFor severe adult degenerative scoliosis, the lateral lumbar interbody fusion can correct the balance of coronal and sagittal planes at the same time, and the effect of staged minimally invasive surgery is reliable.