Clinical Study| Volume 20, ISSUE 11, P1558-1563, November 2013

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Extreme lateral interbody fusion for the treatment of adult degenerative scoliosis


      Extreme lateral interbody fusion (XLIF; NuVasive Inc., San Diego, CA, USA) is a minimally invasive lateral transpsoas approach to the thoracolumbar spine. Though the procedure is rapidly increasing in popularity, limited data is available regarding its use in deformity surgery. We aimed to evaluate radiographic correction using XLIF in adults with degenerative lumbar scoliosis. Thirty consecutive patients were followed for an average of 14.3 months. Interbody fusion was completed using the XLIF technique with supplemental posterior instrumentation. Plain radiographs were obtained on all patients preoperatively, postoperatively, and at most recent follow-up. Plain radiographic measurements of coronal Cobb angle, apical vertebral translation, segmental lordosis, global lordosis, disc height, neuroforaminal height and neuroforaminal width were made at each time point. CT scans were obtained for all patients 1 year after surgery to evaluate for fusion. There was significant improvement in multiple radiographic parameters from preoperative to postoperative. Cobb angle corrected 72.3%, apical vertebral translation corrected 59.7%, neuroforaminal height increased 80.3%, neuroforaminal width increased 7.4%, and disc height increased 116.7%. Segmental lordosis at L4–L5 increased 14.1% and global lordosis increased 11.5%. There was no significant loss of correction from postoperative to most recent follow-up. There was an 11.8% pseudoarthrosis rate at levels treated with XLIF. Complications included lateral incisional hernia (n = 1), rupture of anterior longitudinal ligament (n = 2), wound breakdown (n = 2), cardiac instability (n = 1), pedicle fracture (n = 1), and nonunion requiring revision (n = 1). XLIF significantly improves coronal plane deformity in patients with adult degenerative scoliosis. XLIF has the ability to correct sagittal plane deformity, although it is most effective at lower lumbar levels.


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        • Oskouian Jr., R.J.
        • Shaffrey C.I.
        Degenerative lumbar scoliosis.
        Neurosurg Clin N Am. 2006; 17: 299-315
        • Daffner S.D.
        • Vaccaro A.R.
        Adult degenerative lumbar scoliosis.
        Am J Orthop (Belle Mead J). 2003; 32 (discussion 82): 77-82
        • Vanderpool D.W.
        • James J.I.
        • Wynne-Davies R.
        Scoliosis in the elderly.
        J Bone Joint Surg Am. 1969; 51: 446-455
        • Tribus C.B.
        Degenerative lumbar scoliosis: evaluation and management.
        J Am Acad Orthop Surg. 2003; 11: 174-183
        • Aebi M.
        The adult scoliosis.
        Eur Spine J. 2005; 14: 925-948
        • Gelalis I.D.
        • Kang J.D.
        Thoracic and lumbar fusions for degenerative disorders: rationale for selecting the appropriate fusion techniques.
        Orthop Clin North Am. 1998; 29: 829-842
        • Gupta M.C.
        Degenerative scoliosis. Options for surgical management.
        Orthop Clin North Am. 2003; 34: 269-279
        • Heary R.F.
        • Kumar S.
        • Bono C.M.
        Decision making in adult deformity.
        Neurosurgery. 2008; 63: 69-77
        • Bradford D.S.
        • Tay B.K.
        • Hu S.S.
        Adult scoliosis: surgical indications, operative management, complications, and outcomes.
        Spine (Phila Pa 1976). 1999; 24: 2617-2629
        • Ozgur B.M.
        • Aryan H.E.
        • Pimenta L.
        • et al.
        Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion.
        Spine J. 2006; 6: 435-443
        • Isaacs R.E.
        • Hyde J.
        • Goodrich J.A.
        • et al.
        A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications.
        Spine (Phila Pa 1976). 2010; 35: S322-S330
        • Youssef J.A.
        • McAfee P.C.
        • Patty C.A.
        • et al.
        Minimally invasive surgery: lateral approach interbody fusion: results and review.
        Spine (Phila Pa 1976). 2010; 35: S302-311
        • Smith W.D.
        • Christian G.
        • Serrano S.
        • et al.
        A comparison of perioperative charges and outcome between open and mini-open approaches for anterior lumbar discectomy and fusion.
        J Clin Neurosci. 2012; 19: 673-680
        • Glassman S.D.
        • Berven S.
        • Bridwell K.
        • et al.
        Correlation of radiographic parameters and clinical symptoms in adult scoliosis.
        Spine (Phila Pa 1976). 2005; 30: 682-688
        • Ploumis A.
        • Liu H.
        • Mehbod A.A.
        • et al.
        A correlation of radiographic and functional measurements in adult degenerative scoliosis.
        Spine (Phila Pa 1976). 2009; 34: 1581-1584
        • Schwab F.J.
        • Smith V.A.
        • Biserni M.
        • et al.
        Adult scoliosis: a quantitative radiographic and clinical analysis.
        Spine (Phila Pa 1976). 2002; 27: 387-392
        • Jackson R.P.
        • Simmons E.H.
        • Stripinis D.
        Coronal and sagittal plane spinal deformities correlating with back pain and pulmonary function in adult idiopathic scoliosis.
        Spine (Phila Pa 1976). 1989; 14: 1391-1397
        • Emami A.
        • Deviren V.
        • Berven S.
        • et al.
        Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation.
        Spine (Phila Pa 1976). 2002; 27: 776-786
        • Good C.R.
        • Lenke L.G.
        • Bridwell K.H.
        • et al.
        Can posterior-only surgery provide similar radiographic and clinical results as combined anterior (thoracotomy/thoracoabdominal)/posterior approaches for adult scoliosis?.
        Spine (Phila Pa 1976). 2010; 35: 210-218
        • Pateder D.B.
        • Kebaish K.M.
        • Cascio B.M.
        • et al.
        Posterior only versus combined anterior and posterior approaches to lumbar scoliosis in adults: a radiographic analysis.
        Spine (Phila Pa 1976). 2007; 32: 1551-1554
        • Baker J.K.
        • Reardon P.R.
        • Reardon M.J.
        • et al.
        Vascular injury in anterior lumbar surgery.
        Spine (Phila Pa 1976). 1993; 18: 2227-2230
        • Rajaraman V.
        • Vingan R.
        • Roth P.
        • et al.
        Visceral and vascular complications resulting from anterior lumbar interbody fusion.
        J Neurosurg. 1999; 91: 60-64
        • Christensen F.B.
        • Bunger C.E.
        Retrograde ejaculation after retroperitoneal lower lumbar interbody fusion.
        Int Orthop. 1997; 21: 176-180
        • Acosta F.L.
        • Liu J.
        • Slimack N.
        • et al.
        Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study.
        J Neurosurg Spine. 2011; 15: 92-96
        • Anand N.
        • Rosemann R.
        • Khalsa B.
        • et al.
        Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis.
        Neurosurg Focus. 2010; 28: E6
        • Dakwar E.
        • Cardona R.F.
        • Smith D.A.
        • et al.
        Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis.
        Neurosurg Focus. 2010; 28: E8
        • Sharma A.K.
        • Kepler C.K.
        • Girardi F.P.
        • et al.
        Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report.
        J Spinal Disord Tech. 2011; 24: 242-250
        • Tormenti M.J.
        • Maserati M.B.
        • Bonfield C.M.
        • et al.
        Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation.
        Neurosurg Focus. 2010; 28: E7
        • Wang M.Y.
        • Mummaneni P.V.
        Minimally invasive surgery for thoracolumbar spinal deformity: initial clinical experience with clinical and radiographic outcomes.
        Neurosurg Focus. 2010; 28: E9
        • Swank S.
        • Lonstein J.E.
        • Moe J.H.
        • et al.
        Surgical treatment of adult scoliosis. A review of two hundred and twenty-two cases.
        J Bone Joint Surg Am. 1981; 63: 268-287
        • Kim Y.J.
        • Bridwell K.H.
        • Lenke L.G.
        • et al.
        Pseudarthrosis in primary fusions for adult idiopathic scoliosis: incidence, risk factors, and outcome analysis.
        Spine (Phila Pa 1976). 2005; 30: 468-474
        • Byrd 3rd., J.A.
        • Scoles P.V.
        • Winter R.B.
        • et al.
        Adult idiopathic scoliosis treated by anterior and posterior spinal fusion.
        J Bone Joint Surg Am. 1987; 69: 843-850
        • Dawson E.G.
        • Clader T.J.
        • Bassett L.W.
        A comparison of different methods used to diagnose pseudarthrosis following posterior spinal fusion for scoliosis.
        J Bone Joint Surg Am. 1985; 67: 1153-1159
        • McMaster M.J.
        Stability of the scoliotic spine after fusion.
        J Bone Joint Surg Br. 1980; 62-B: 59-64
        • Sponseller P.D.
        • Cohen M.S.
        • Nachemson A.L.
        • et al.
        Results of surgical treatment of adults with idiopathic scoliosis.
        J Bone Joint Surg Am. 1987; 69: 667-675
        • Wenger D.R.
        • Mubarak S.J.
        • Leach J.
        Managing complications of posterior spinal instrumentation and fusion.
        Clin Orthop Relat Res. 1992; : 24-33