Analysis of efficacies of posterior osteotomy and oblique lumbar interbody fusion under O-arm navigation in the treatment of degenerative scoliosis

English Keywords:Degenerative diseases  Scoliosis  Surgery  Computer-aided  Spinal fusion

English Abstract:

  【Abstract】 Objectives: To investigate the clinical efficacy and safety of posterior O-arm navigated internal fixation+osteotomy orthopedic surgery and anterior oblique lumbar interbody fusion(OLIF)+posterior O-arm navigated internal fixation in the treatment of patients with degenerative scoliosis. Methods: A retrospective analysis was performed on the 55 patients with degenerative scoliosis who were treated in our hospital between May 2016 and June 2023. According to surgical method, the patients were divided into posterior O-arm navigated internal fixation+osteotomy orthopedic group(group A, 20 cases) and anterior OLIF+posterior O-arm navigated internal fixation group(group B, 25 cases). Group A consisted of 8 males and 12 females, aged 47-81(66.4±7.4) years old; Group B consisted of 8 males and 17 females, aged 52-81(67.4±8.2) years old. The perioperative data of the patients were collected, and the visual analogue scale(VAS) score and Oswestry disability index(ODI) were recorded before operation, at postoperative 1 week and final follow-up to evaluate the clinical efficacy, and full-length spinal X-ray were taken in the standing position at the same time point to measure the coronal Cobb angle, sagittal vertical axis(SVA), lumbar lordosis(LL), intervertebral space height, vertebral fusion rate. The complications were recorded and compared between groups. Results: The patients were followed up for 18-38(26.5±5.3) months in group A and 20-36(24.3±4.2) months in group B, with no statistical difference(P>0.05). Statistical differences(P<0.05) were observed between group A and group B in operative time(219.0±25.7min vs 169.4±25.6min), intraoperative blood loss(1087.5±353.1mL vs 672.5±308.6mL), postoperative drainage volume(364.7±22.9mL vs 109.3±25.3mL), postoperative ambulation time(11.0±3.4d vs 6.3±1.8d), and number of blood transfusions(18 vs 8). The VAS scores were 6.2±0.9 points and 1.8±0.8 points in group A at postoperative 1 week and final follow-up respectively, which were 4.4±0.9 and 1.3±0.5 in group B, and group B was lower than group A at the same postoperative time point(P<0.05). The ODI of group A and group B at postoperative 1 week were (22.8±4.8)% and (19.9±2.9)%, and group B was lower than group A(P<0.05), while there was no significant difference between the two groups at final follow-up(P>0.05). At postoperative 1 week and final follow-up, the sagittal SVA of group A was 47.0±11.5mm and 43.9±19.7mm, which was 35.2±19.9mm and 30.9±19.9mm in group B, and the sagittal correction in group A was better than that in group B(P<0.05). There was no statistical difference between the two groups in coronal Cobb angle and LL at postoperative 1 week and final follow-up(P>0.05). The intervertebral space height of group A was 48.1±8.2mm and 46.1±8.5mm at postoperative 1 week and final follow-up, which was 57.4±5.4mm and 56.3±5.6mm in group B, and group B was better than group A(P<0.05). There were 2 cases of postoperative cerebrospinal fluid leakage, 2 cases of delayed incision healing, 1 case of nail and rod fracture, 1 case of screw loosening in group A, and the complication rate was 30%(6/20); 2 cases in group B had postoperative pain on the anteromedial side of the left thigh, and 2 cases had transient left hip flexion weakness, all of which recovered at follow-up, and the complication rate was 16%(4/25). The complication rate was higher in group A than group B(P<0.05). Both groups had no incision infection or spinal cord injury complications. At final follow-up, the bone graft and fusion device were osseous fusion in both groups. Conclusions: Both posterior O-arm navigated internal fixation+osteotomy orthopedic surgery and anterior OLIF+posterior O-arm navigated internal fixation can achieve satisfactory clinical efficacy in the treatment of degenerative scoliosis, the former has better sagittal orthopedic effect, but has the problems of long operative time, large amount of bleeding, long postoperative bed rest, and many complications, while the latter has a similar scoliosis correction, as well as the advantages of minimally invasive, less traumatic, fast recovery and fewer complications, which can provide a new option for the minimally invasive treatment of degenerative scoliosis.