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Adult Degenerative Scoliosis Treated With XLIF: Clinical and Radiographical Results of a Prospective Multicenter Study With 24-Month Follow-up

Phillips, Frank M. MD*; Isaacs, Robert E. MD; Rodgers, William Blake MD; Khajavi, Kaveh MD§,¶; Tohmeh, Antoine G. MD; Deviren, Vedat MD**; Peterson, Mark D. MD††; Hyde, Jonathan MD‡‡; Kurd, Mark MD*,§§

doi: 10.1097/BRS.0b013e3182a43f0b

Study Design. Prospective, multicenter, single-arm study.

Objective. The objective of this study was to evaluate the clinical and radiographical results of patients undergoing extreme lateral interbody fusion (XLIF), a minimally disruptive lateral transpsoas retroperitoneal surgical approach for the treatment of degenerative scoliosis (DS).

Summary of Background Data. Surgery for the treatment of DS has been reported to have acceptable results but is traditionally associated with high morbidity and complication rates. A minimally disruptive lateral transpsoas retroperitoneal surgical approach (XLIF) has become popular for the treatment of DS. This is the first prospective, multicenter study to quantify outcomes after XLIF in this patient population.

Methods. A total of 107 patients with DS who underwent the XLIF procedure with or without supplemental posterior fixation at one or more intervertebral levels were enrolled in this study. Clinical and radiographical results were evaluated up to 24 months after surgery.

Results. Mean patient age was 68 years; 73% of patients were female. A mean of 3.0 (range, 1–6) levels were treated with XLIF per patient. Overall complication rate was low compared with traditional surgical treatment of DS. Significant improvement was seen in all clinical outcome measures at 24 months: Oswestry Disability Index, visual analogue scale for back pain and leg pain, and 36-Item Short Form Health Survey mental and physical component summaries (P < 0.001). Eighty-five percent of patients were satisfied with their outcome and would undergo the procedure again. In patients with hypolordosis, lumbar lordosis was corrected from a mean of 27.7° to 33.6° at 24 months (P < 0.001). Overall Cobb angle was corrected from 20.9° to 15.2°, with the greatest correction observed in patients supplemented with bilateral pedicle screws.

Conclusion. This study demonstrates the use of the XLIF procedure in the treatment of DS. XLIF is associated with good clinical and radiographical outcomes, with a substantially lower complication rate than has been reported with traditional surgical procedures.

Level of Evidence: 3

Traditional surgical treatment of degenerative scoliosis is associated with high morbidity and complication rates. The 24-month clinical and radiographical results of a prospective multicenter study on a minimally disruptive lateral transpsoas (XLIF) approach for interbody fusion in the treatment of degenerative scoliosis are similar to those after traditional open surgical procedures, with substantially fewer complications.

*Midwest Orthopaedics at Rush University Medical Center, Chicago, IL

Division of Neurosurgery, Duke University Medical Center, Durham, NC

Spine Midwest, Inc., Jefferson City, MO

§Georgia Spine and Neurosurgery Center, Decatur, GA

INSPIRE Research Foundation, Atlanta, GA

Northwest Orthopaedic Specialists, Spokane, WA

**Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA

††Southern Oregon Orthopedics, Medford, OR

‡‡South Florida Spine Institute, Miami Beach, FL; and

§§OrthoCarolina, Charlotte, NC.

Address correspondence and reprint requests to Frank M. Phillips, MD, Midwest Orthopaedics at Rush University Medical Center, 1611 W. Harrison St, Ste 360, Chicago, IL 60612; E-mail:

Acknowledgment date: May 14, 2013. First revision date: June 17, 2013. Acceptance date: June 30, 2013.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

NuVasive, Inc, funds were received to support this work.

Relevant financial activities outside the submitted work: board membership, grant/grants pending, consultancy fee or honorarium, support for travel, fees for participation in review activities, provision of writing assistance, medicines, equipment, or administrative support, consultancy, payment for lectures, travel/accommodations/meeting expenses, royalties, stock/stock options, payment for development of educational presentations, and patents.

© 2013 by Lippincott Williams & Wilkins