Treatment of degenerative lumbar scoliosis by using modified MI-TLIF and percutaneous pedicle screw fixation
YIN Zhixun
HE Erxing
CUI Jihao
WU Meixiang
SHI Zhongyu
LIU Chaojie
Abstract：Objective To discuss the operative essentials and therapeutic effects of modified minimally invasive-transforaminal lumbar interbody fusion (MI-TLIF) combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis (DLS). Methods From march 2012 to march 2014, 32 DLS patients were treated by modified MI-TLIF (concave-side distraction step by step, cage insertion into the curved side of intervertebral space, and bone graft fusion) and percutaneous pedicle screw fixation in the First and Fouth Affiliated Hospital of Guangzhou Medical College. Incision length, operative time, intraoperative estimate blood loss and hospital stay were recorded, Cobb's angle, lordosis angle and spinal imbalance distances on coronal and sagittal plane were measured according to preoperative and postoperative spinal full-length radiographs, postoperative improvement of low back and leg pain were evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI) scoring, clinical effects were assessed according to Nakai standard. Results Incision length was 4.2-5.3 cm with the average of 4.5 cm, operative time was 85-165 min with the average of 110 min, intraoperative estimate blood loss was 120 mL (90-300 mL) and the hospital stay was 14.5 d (11-17 d). Thirty patients were followed-up for 12.5 months (4-23 months). No pedicle screw-rod breakage or cage displacement were found. Compared with preoperative and the last follow-up, the following results had statistical differences (P<0.05):VAS of low back pain and leg pain decreased from (6.8 ± 2.3), (7.5 ± 2.2) to (1.9 ± 1.3), (2.4 ± 1.5) respectively, ODI improved from (41.4 ± 2.7)% to (13.6 ± 2.5)%; Cobb's angle decreased from (33.7 ± 3.5)° to (10.1 ± 2.3)°, lordosis angle deviation decreased from (22.6 ± 8.0)° to (3.3 ± 1.4)°; Imbalance distance on sagittal plane and coronal plane improved from (46.8 ± 9.8), (29.3 ± 7.8) mm to (19.7 ± 7.6), (10.7 ± 6.3) mm respectively. According to Macnab standard, there were excellent in 20 cases, good in 6 cases, fair in 3 cases and poor in 1 case, with the excellent and good rate of 87%. Conclusion Modified MI-TLIF combined with percutaneous pedicle screw fixation is an effective technique for treatment of DLS patients, with less injury, short operative time, less blood loss, low complication incidence, good scoliosis correction and definite therapeutic effects.
Keywords：Lumbar vertebraeScoliosisDegenerative diseasesSpinal fusionSurgical proceduresminorPercutaneous pedicle screw fixation
Publication Date：2014-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：8( 210-217 )