Comparison of staged reconstruction with extreme lateral interbody fusion (XLIF) adult thoracolumbar kyphoscoliotic deformity

Transcription

1 Comparison of staged reconstruction with extreme lateral interbody fusion (XLIF) and multilevel corrective PLIF/TLIF for adult thoracolumbar kyphoscoliotic deformity Hidetoshi Yamaguchi, MD; Tokumi Kanemura,MD, Kotaro Satake, MD; Naoki Segi, MD Orthopaedic Surgery, Konan Kosei Hospital, Konan, JAPAN

2 Purpose To compare radiological and clinical outcomes between two-stage reconstruction with multilevel XLIF (mxlif) and one-stage multilevel corrective PLIF/TLIF (mplif) for degenerative deformities in Japanese elderly patients.

3 Patients A retrospective consecutive series of 30 patients surgical treatment for adult deformities at Konan Kosei Hospital from November 2010 to May 2014 Inclusion criteria: age >50 years coronal Cobb >30, or coronal Cobb >20 and LL <20 instrumentation from the lower thoracic spine to the pelvis at least 1 year of follow-up Exclusion criteria: PSO, VCR and anterior spinal reconstruction prior lumbar fusion surgery neoplasia, trauma, or infection.

4 Methods 30 patients (7 men, 23 women) 70.4 ± 8.3 years; range, years The mplif group (n = 15) one-stage posterior fusion with multilevel corrective PLIF/TLIF and Ponte s osteotomy via an open approach. The mxlif group (n = 15) a first-stage multilevel XLIF a second-stage posterior instrumentation involving PLIF/TLIF at the L5-S1 level via an open approach after one week of the first-stage

5 Evaluation Surgical outcomes operating time, blood loss volume, ICU admission, etc. Clinical results the JOA score, VAS score perioperative complications Radiologic parameters coronal Cobb angle (CC), C7-CSVL SVA, PT, PI, LL using the Wilcoxon signed-rank test for continuous data and the Mann Whitney U test for categorical data using SPSS software

6 Surgical outcomes characteristics mplif (n=15) mxlif (n=15) p-value average age (yr) 69.6± ± * Fixation levels 8.1± ± * operating time (min) intraoperative blood loss (ml) postoperative blood loss (ml) 548±61 567± * 3515± ±428 <0.001* 1165± ± * admission to the ICU ** Values are presented as mean±standard deviation. *Mann-Whitney U test, ** kai square test EBL was about three times as much in the mplif as in the mxlif.

7 Clinical results mplif (n=15) mxlif (n=15) p-value VAS leg pre-ope. 74.3± ±22.0 post 1yr 35.3± ±20.1 Improvement 39.0± ± * VAS back pre-ope. 71.5± ±22.0 post 1yr 27.8± ±12.4 Improvement 44.3± ± * JOA score pre-ope. 11.6± ±4.6 post 1yr 22.1± ±3.2 Recovery rate 59.5± ± * Values are presented as mean±standard deviation. *Mann-Whitney U test,

8 Complications Surgical Medical mplif (n=15) 8 (53.3%) dural tear 6 motor radiculopathy 1 sensory radiculopathy 2 8 (53.3%) congestive heart failure 4 urinary tract infection 3 post-anesthesia delirium 2 cerebral infarction 1 obstructive jaundice 1 hyponatremia 1 hypotension associated with adrenal malfunction 1 mxlif (n=15) 6 (40.0%) dural tear 1 hip flexion weakness 2 groin pain 2 thigh pain and numbness 2 abdominal wall paralysis 1 2 (13.3%) urinary tract infection 1 post-anesthesia delirium 1 There is some overlapping in this table

9 Radiologic parameters 1 variable mplif (n=15) mxlif (n=15) p-value Coronal Cobb Preop Post 1m Post 1y decrease 32.5± ± ± ± ± ± ± ± C7-CSVL Preop Post 1m Post 1y decrease 28.4± ± ± ± ± ± ± ± Lumbar lordosis Preop Post 1m Post 1y increase 20.7± ± ± ± ± ± ± ± <0.001

10 Radiologic parameters 2 variable mplif (n=15) mxlif (n=15) p-value SVA Preop Post 1m Post 1y decrease 82.9± ± ± ± ± ± ± ± PT Preop Post 1m Post 1y decrease 28.2± ± ± ± ± ± ± ± PI-LL Preop Post 1m Post 1y decrease 27.7± ± ± ± ± ± ± ± <0.001

11 Conclusion This retrospective study indicates that the multilevel XLIF procedure is a less invasive technique than the multilevel corrective PLIF/TLIF procedure for the treatment of degenerative scoliosis and kyphoscoliosis, in Japanese elderly patients. We conclude that staged reconstruction for adult degenerative deformities is a reasonable approach, and affords effective correction with acceptable complication rates.

12 COI disclosures Yamaguchi H; nothing to be disclosed Kanemura T; Consultancy of AOSpine, NuVasive, DePuySynthes Japan, and Medtronic Japan, Co Ltd. Expert testimony of Ministry of Health, Labour, and Welfare, Japan Satake K; nothing to be disclosed Segi N; nothing to be disclosed