Comparison of complications and clinical outcomes between extreme lateral/posterior and open anterior/posterior approaches in the treatment of adult scoliosis
Honglei YI
Jiawei LIAO
Oheneba Boachie-Adjei
Zenghui WU
Hong XIA
Abstract：Objectives To determine the differences of clinical outcome and complications between combined extreme lateral/posterior (X/P) approach and open anterior/posterior (A/P) approach for treatment of adult scoliosis. Methods Twelve patients who had X/P fusion for primary adult scoliosis were matched with a cohort of 18 patients who underwent A/P treatment. Open anterior fusion was performed via a thoracotomy/thoracoabdominal approach, and extreme lateral interbody fusion (XLIF) was performed using an expandable tubular retractor through a transpsoas access to the target disc space. All of the patients were followed up at least 2 years. Operating time, estimate blood loss (EBL) and transfusion volume were noted, radiographic parameters were evaluated before surgery and at fi nal follow-up, and Scoliosis Research Society (SRS)-22 score, Oswestry disability index (ODI) as well as complications were recorded. Results There were no significant differences between two groups for age, gender, diagnosis, preoperative curve magnitudes and fusion levels. EBL was statistically less in X/P than A/P group (2304 vs 3176 mL, P = 0.04), and there was a trend toward shorter surgical time (493 vs 528 min, P = 0.057). Postoperative radiographic coronal correction were almost the same between two groups. There were 14 complications including 4 perioperative and 10 late in X/P group, comparing to A/P group with 11 perioperative and 12 late complications, which showed no significant differences between two groups (P >0.05). Wound infection was found in 3 A/P patients while no X/P patients was infected (P =0.26). Early revision surgery was performed in 0 X/P patients and 3 A/P patients without significant difference (P = 0.26). Pseudarthrosis rates found in X/P versus A/P group (3/12 vs 1/18) were not significantly different (P =0.27). The occurrence rate of proximal junctional kyphosis (PJK) was the same (5/12 vs 7/18) in two groups. SRS-22 score and ODI in two groups reflected a similar patient assessment before surgery, and improvement at the last follow-up. Conclusions Combined X/P approach surgery in the treatment of adult scoliosis can achieve similar significant coronal correction to A/P surgery with decreased EBL, and a tendency of shorter surgical time. It also presented a declining trend in the rates of perioperative complications, wound infection and requirement for early reoperation. There was a tendency of higher lumbosacral pseudarthrosis rate in X/P group. Late complications and clinical outcomes were similar at over 2-year follow-up.
Keywords：ScoliosisSpinal fusionExtreme lateral interbody fusionAnteroposterior fusionPostoperative complicationsAdult
Publication Date：2017-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：13( 331-343 )