11 research outputs found
Surgical management of coronal and sagittal imbalance of the spine without PSO: a multicentric cohort study on compensated adult degenerative deformities
Purpose Sagittal imbalance of severe adult degenerative
deformities requires surgical correction to improve pain,
mobility and quality of life. Our aim was a harmonic and
balanced spine, treating a series of adult degenerative
thoracolumbar and lumbar kyphoscoliosis by a non posterior
subtraction osteotomy technique.
Methods We operated 22 painful thoracolumbar and lumbar
compensated degenerative deformities by anterior
(ALIF), extreme lateral (XLIF) and transforaminal (TLIF)
interbody fusion and grade 2 osteotomy (SPO) to restore
lumbar lordosis and mobilize the coronal curve. Two-stage
surgery, first anterior and after 2 or 3 weeks posterior, was
proposed when the Oswestry Disability Index (ODI) was
equal to or greater than 50% and VAS more than 5. All
patients were submitted to X-ray and clinical screening
during pre, post-operative and follow-up periods.
Results We performed 5 ALIFs, 39 XLIFs, 8 TLIFs, 32
SPOs. No major complications were recorded and complication
rate was 18% after lateral fusion and 22.7% after
posterior approach. Pelvic tilt, lumbar lordosis, sagittal
vertical axis and thoracic kyphosis improved (p\0.05).
Clinical follow-up (mean 20.5; range 18–24) was
satisfactory in all cases, except for two due to sacroiliac
pain. Mean preoperative VAS was 7.7 (range 6–10), while
ODI was 67% on average (range 50–78). After two-stage
surgery, VAS and ODI decreased, respectively, to 2.4 (range
2–4) and 31% (range 25–45), while their values were 4
(range 2-6) and 35% (range 20–55) at the final follow-up.
Conclusion Current follow-up does not allow definitive
conclusions. However, the surgical approach adopted in
this study seems promising, improving balance and clinical
condition of adult patients with a compensated sagittal
degenerative imbalance of the thoracolumbar spine