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. 2018 Sep;4(3):610-615.
doi: 10.21037/jss.2018.07.11.

Extreme lateral lumbar interbody fusion (XLIF) in the management of degenerative scoliosis: a retrospective case series

Konstantinos N Paterakis  1   2 , Alexandros G Brotis  2 , Athanasios Paschalis  2 , Alkiviadis Tzannis  2 , Konstantinos N Fountas  1   2
Affiliations

Extreme lateral lumbar interbody fusion (XLIF) in the management of degenerative scoliosis: a retrospective case series

Konstantinos N Paterakis et al. J Spine Surg. 2018 Sep.

Abstract

Background: Surgical treatment of adult degenerative scoliosis (DS) always remains a challenge and often necessitates complex multilevel surgery via traditional open approaches. However, the severity of the procedure, in association with the fact that many of these patients are at an advanced age with several comorbidities, results in high rate of complications. Therefore, during the last decade, minimally invasive procedures have gained a place in the treatment of this pathology. Our aim is to determine the safety and efficacy of extra lateral lumbar interbody fusion (XLIF) with or without supplemented instrumentation in the treatment of DS.

Methods: In a retrospective case series study, we reviewed the files of patients who underwent XLIF in our Hospital between 2008 and 2017. We recorded the patients' demographic characteristics, clinical parameters such as back-pain [visual analogue scale (VAS)] and back-related disability [Oswestry Disability Index (ODI)], as well as radiological parameters including the Cobb angle. Comparison of the before and after results were performed with the t-test and Chi-square test, where appropriate.

Results: Twelve patients fulfilled the eligibility criteria of our study. All patients were female, with a mean age of 64.5 years (SD =7.8 years) and 28 months (SD =13 months) follow-up. The XLIF decreased the pain intensity by 4.66 cm (SD =1.23 cm), and improved the back-related disability by 26% (SD =8.35%) in the ODI scale at the 6-month follow-up. Similarly, scoliosis improved by an average of 11.5° (SD =7°) and lordosis changed by an average of 13.5° (SD =10.86°). All changes were statistically significant. There were three complications, two patients presented meralgia paresthetica, which resolved spontaneously in 3 months, and in one patient occurred an intraoperative bowel perforation treated with bowel anastomosis.

Conclusions: XLIF is a feasible and efficient alternative in the treatment of DS. It can be the treatment of choice in elderly patients in whom comorbidities increase the perioperative risk of complications.

Keywords: Cobb angle; Degenerative scoliosis (DS); back pain; back-related disability; extreme lateral lumbar interbody fusion (XLIF).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Back-related pain improved significantly after surgery. VAS, visual analogue scale.
Figure 2
Figure 2
Back-related disability improved significantly after surgery. ODI, Oswestry Disability Index.
Figure 3
Figure 3
Scoliosis improved significantly after surgery.
Figure 4
Figure 4
The sagittal plane angle improved significantly after surgery.
Figure 5
Figure 5
A 56-year-old patient presented with mechanical back pain. (A,B). The preoperative radiographs indicated severe degenerative scoliosis. (C,D) Postoperative radiographs of the same patient. The 3D spinal alignment was improved with use of extreme lateral interbody fusion at multiple levels, augmented by a posterior lumbar fusion.
See this image and copyright information in PMC

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