Comparison of efficacies between transforaminal endoscopic decompression and limited decompression and fusion in the treatment of adult degenerative scoliosis

English Keywords:Adult degenerative scoliosis  Foraminal stenosis  Lower limb radiculopathy  Transforaminal endoscopic decompression

English Abstract:

  【Abstract】 Objectives: To investigate the characteristics of clinical and imaging outcomes and their differences between transforaminal endoscopic decompression and limited decompression and fusion surgery in the treatment of adult degenerative scoliosis(ADS). Methods: From January 2018 to January 2021, 53 patients suffering from ADS who underwent surgery in our department were retrospectively analyzed, and they were divided into either minimally invasive surgery(MIS) group(31 patients, underwent transforaminal endoscopic decompression) or fusion group(22 patients, underwent limited decompression and fusion surgery). The following data were comparatively analyzed: the baseline characteristics, the preoperative Lenke-Silva level, the radiographical parameters(scoliotic Cobb angle, global spinal balance parameters, and spinopelvic parameters) that measured at preoperation, before discharge, at six months after surgery, and at the final follow-up, clinical outcomes that evaluated at preoperation, before discharge, three months after surgery, six months after surgery, and the final follow-up, the incidence of surgical complications, and the reoperation rate. Results: The mean follow-up period was 15.68±3.26 months. The mean age of the patients in the MIS group was significantly higher than that in the fusion group(78.64±5.19 years vs 64.95±4.31 years, P<0.05). In the MIS group, the majority of the patients were classified as Lenke-Silva Ⅰ and Ⅱ, and all the patients suffered from unilateral lower limb radiculopathy; In the fusion group, more patients were of Lenke-Silva Ⅱ and Ⅲ levels, and 73% of the patients suffered from unilateral lower limb radiculopathy. The preoperative scoliotic Cobb angle in the MIS group was significantly smaller than that in the fusion group(23.92°±9.06° vs 39.58°±13.12°, P<0.05). Postoperatively, both groups of patients showed significantly improvement in back pain, leg pain, and functional disability. At the final follow-up, the scores for back pain and functional disability showed preferably improvement in the MIS group than those in the fusion group(P<0.05). During the postoperative follow-up, no coronal or sagittal imbalance was observed in both groups; At the final follow-up: the mean scoliotic Cobb angle progressed 1.51° in the MIS group, while the correction of scoliosis reduced 1.82° in the fusion group. The operative time, intraoperative blood loss, incidence of complications, and the reoperation rate in the MIS group were significantly lower than those in the fusion group(P<0.05). Conclusions: For ADS patients without rigid imbalance, both surgical interventions are able to significantly improve clinical symptoms. The short-term follow-up outcomes reveal that the endoscopic decompression superiors in less scoliosis progression after operation and functional improvement than limited fusion surgery.