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Minimally Invasive Multilevel Percutaneous Correction and Fusion for Adult Lumbar Degenerative Scoliosis: A Technique and Feasibility Study

Anand, Neel MD; Baron, Eli M. MD; Thaiyananthan, Gowriharan MD; Khalsa, Kunwar BS; Goldstein, Theodore B. MD

Journal of Spinal Disorders & Techniques: October 2008 - Volume 21 - Issue 7 - pp 459-467
doi: 10.1097/BSD.0b013e318167b06b
Original Articles

Study Design: Prospective evaluation of 12 patients undergoing surgery for lumbar degenerative scoliosis.

Objective: To assess the feasibility of minimally invasive spine surgery (MIS) techniques in the correction of lumbar degenerative deformity.

Summary of Background Data: Patient age, comorbidities, and blood loss may be limiting factors when considering surgical correction of lumbar degenerative scoliosis. MIS may allow for significantly less blood loss and tissue disruption than open surgery.

Methods: Twelve patients underwent circumferential fusion. The age range of these patients was 50 to 85 years (mean of 72.8 y). Of the 12 patients, 7 were men and 5 were women. All patients underwent direct lateral transpsoas approach for discectomy and fusion with polyetheretherketone cage and rh-BMP2. All fusions to the sacrum included L5-S1 fusion with the Trans1 Axial Lumbar Interbody Fusion technique. Posteriorly, multilevel percutaneous screws were inserted using the CD Horizon Longitude system. Radiographs, visual analog scores (VAS), and treatment intensity scores (TIS) were assessed preoperatively and at last postoperative visit. Operative times and estimated blood loss were recorded.

Results: Mean number of segments operated on was 3.64 (range: 2 to 8 segments). Mean blood loss for anterior procedures (transpsoas discectomy/fusion and in some cases L5-S1 interbody fusion) was 163.89 mL (SD 105.41) and for posterior percutaneous pedicle screw fixation (and in some cases L5-S1 interbody fusion) was 93.33 mL (SD 101.43). Mean surgical time for anterior procedures was 4.01 hours (SD 1.88) and for posterior procedures was 3.99 hours (SD 1.19). Mean Cobb angle preoperatively was 18.93 degrees (SD 10.48) and postoperatively was 6.19 degrees (SD 7.20). Mean preoperative VAS score was 7.1; mean preoperative TIS score was 56.0. At mean follow-up of 75.5 days, mean VAS was 4.8; TIS was 28.0.

Conclusions: A combination of 3 MIS techniques allows for correction of lumbar degenerative scoliosis. Multisegment correction can be performed with less blood loss and morbidity than for open correction.

Department of Surgery, Institute for Spinal Disorders, Cedars-Sinai Medical Center, Los Angeles, CA

Reprints: Neel Anand, MD, Institute for Spinal Disorders, Cedars-Sinai Medical Center, 444 S. San Vicente Blvd., Suite 800, Los Angeles, CA 90048 (e-mail: neel.anand@cshs.org).

Received for publication October 26, 2007; accepted January 5, 2008

© 2008 Lippincott Williams & Wilkins, Inc.