Clinical evaluation of multi-level oblique lumbar interbody fusion combined with posterior internal fixation in the treatment of lumbar degenerative scoliosis with sagittal imbalance

English Keywords:Lumbar degenerative scoliosis  Oblique lumbar interbody fusion  Spinal sagittal imbalance

English Abstract:

  【Abstract】 Objectives: To retrospectively analyze the effect of multi-level oblique lumbar interbody fusion (OLIF) combined with posterior internal fixation in the treatment of lumbar degenerative scoliosis with sagittal and coronal imbalance. Methods: 17 patients with lumbar degenerative scoliosis who were treated with multi-level OLIF combined with posterior internal fixation in our hospital from September 2017 to April 2020 were retrospectively analyzed, including 3 males and 14 females with a mean age of 67.8±6.3 years(55-81 years) and mean follow-up time of 25.9±7.6 months(13-39 months). The coronal and sagittal parameters of spine were measured and analyzed at preoperation, postoperation, and the last follow-up, including scoliosis Cobb angle, C7 plumb line-center sacral vertical line(C7PL-CSVL), thoracic kyphosis(TK), thoracolumbar kyphosis (TLK), lumbar lordosis(LL), lordosis distribution index(LDI), sagittal vertical axis(SVA), spino-sacral angle (SSA), global tilt(GT), global alignment and proportion score(GAP score), pelvic incidence(PI), pelvic tilt(PT), and sacral slope(SS). The function scores of patients were recorded and analyzed at preoperation, postoperation, and the last follow-up, including Oswestry disability index(ODI), Japanese Orthopaedic Association(JOA) scores, and visual analogue scale(VAS) of the low back and the lower limbs. The imaging and clinical indicators of preoperative, postoperative and the last follow-up were analyzed statistically. Results: All the 17 patients underwent surgical intervention with a mean operation time of 327.4±85.4mins(120-480mins), mean intraoperative blood loss of 504.7±275.1ml(50-1100ml), and mean fusion levels of 3.8±1.2(3-8). The surgical complications occurred in 2 patients, with 1 case of numbness over the inguinal area on the left side relieved with mecobalamin 20 days after surgery; 1 case of vertebral endplate fracture coped with changing insertion pathway away from fracture area and immediate posterior pedicle screw fixation, with no subsidence of cage occurred at follow up. The Cobb angle, C7PL-CSVL, TK, TLK, LL, LDI, GT, GAP scores, PT and SS were significantly improved after surgery and at last follow-up(P<0.05), indicating the sagittal balance of lumbar spine was significantly improved after surgery. The postoperative functional scores of patients with lumbar degenerative scoliosis(ODI, JOA scores, and VAS of the low back and the lower limbs) were significantly improved after surgery and at the last follow-up(P<0.05). Conclusions: Multi-level OLIF combined with posterior internal fixation is a safe and effective treatment strategy, which can help patients with lumbar degenerative scoliosis relieve the symptoms and improve the quality of life, with the correction of three-dimensional deformity, stabilization of spine, and reconstruction of sagittal and coronal balance.