Adult thoracolumbar and lumbar scoliosis treated with long vertebral fusion to the sacropelvis

A comparison between new hybrid selective spinal fusion versus anterior-posterior spinal instrumentation

Mitsuru Yagi, Ravi Patel, Thomas W. Lawhorne, Matthew E. Cunningham, Oheneba Boachie-Adjei

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background context: Combined anteroposterior spinal fusion with instrumentation has been used for many years to treat adult thoracolumbar/lumbar scoliosis. This surgery remains a technical challenge to spine surgeons, and current literature reports high complication rates. Purpose: The purpose of this study is to validate a new hybrid technique (a combination of single-rod anterior instrumentation and a shorter posterior instrumentation to the sacrum) to treat adult thoracolumbar/lumbar scoliosis. Study design: This study is a retrospective consecutive case series of surgically treated patients with adult lumbar or thoracolumbar scoliosis. Patient sample :This is a retrospective study of 33 matched pairs of patients with adult scoliosis who underwent two different surgical procedures: a new hybrid technique versus a third-generation anteroposterior spinal fusion. Outcome measures: Preoperative and postoperative outcome measures include self-report measures, physiological measures, and functional measures. Methods: In a retrospective case-control study, 33 patients treated with the hybrid technique were matched with 33 patients treated with traditional anteroposterior fusion based on preoperative radiographic parameters. Mean follow-up in the hybrid group was 5.3 years (range, 2-11 years), compared with 4.6 years (range, 2-10 years) in the control group. Operating room (OR) time, estimated blood loss, and levels fused were collected as surrogates for surgical morbidity. Radiographic parameters were collected preoperatively, postoperatively, and at final follow-up. The Scoliosis Research Society Patient Questionnaire (SRS-22r) and Oswestry Disability Index (ODI) scores were collected for clinical outcomes. Results: Operating room time, EBL, and levels fused were significantly less in the hybrid group compared with the control group (p<.0001). The postoperative thoracic Cobb angle was similar between the hybrid and control techniques (p=.24); however, the hybrid technique showed significant improvement in the thoracolumbar/lumbar curves (p=.004) and the lumbosacral fractional curve (p<.0001). The major complication rate was less in the hybrid group compared with the control group (18% vs. 39%, p=.01). Clinical outcomes at final follow-up were not significantly different based on overall SRS-22r scores and ODI scores. Conclusion: The new hybrid technique demonstrates good long-term results, with less morbidity and fewer complications than traditional anteroposterior surgery select patients with thoracolumbar/lumbar scoliosis. This study received no funding. No potential conflict of interest-associated bias existed.

Original languageEnglish
Pages (from-to)637-645
Number of pages9
JournalSpine Journal
Volume14
Issue number4
DOIs
Publication statusPublished - 2014 Apr 1
Externally publishedYes

Fingerprint

Spinal Fusion
Scoliosis
Operating Rooms
Control Groups
Outcome Assessment (Health Care)
Morbidity
Sacrum
Conflict of Interest
Self Report
Case-Control Studies
Spine
Thorax
Retrospective Studies
Research

Keywords

  • Adult idiopathic degenerative scoliosis
  • Anterior instrumentation
  • Anteroposterior spinal fusion
  • Long posterior spinal instrumentation

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Adult thoracolumbar and lumbar scoliosis treated with long vertebral fusion to the sacropelvis : A comparison between new hybrid selective spinal fusion versus anterior-posterior spinal instrumentation. / Yagi, Mitsuru; Patel, Ravi; Lawhorne, Thomas W.; Cunningham, Matthew E.; Boachie-Adjei, Oheneba.

In: Spine Journal, Vol. 14, No. 4, 01.04.2014, p. 637-645.

Research output: Contribution to journalArticle

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abstract = "Background context: Combined anteroposterior spinal fusion with instrumentation has been used for many years to treat adult thoracolumbar/lumbar scoliosis. This surgery remains a technical challenge to spine surgeons, and current literature reports high complication rates. Purpose: The purpose of this study is to validate a new hybrid technique (a combination of single-rod anterior instrumentation and a shorter posterior instrumentation to the sacrum) to treat adult thoracolumbar/lumbar scoliosis. Study design: This study is a retrospective consecutive case series of surgically treated patients with adult lumbar or thoracolumbar scoliosis. Patient sample :This is a retrospective study of 33 matched pairs of patients with adult scoliosis who underwent two different surgical procedures: a new hybrid technique versus a third-generation anteroposterior spinal fusion. Outcome measures: Preoperative and postoperative outcome measures include self-report measures, physiological measures, and functional measures. Methods: In a retrospective case-control study, 33 patients treated with the hybrid technique were matched with 33 patients treated with traditional anteroposterior fusion based on preoperative radiographic parameters. Mean follow-up in the hybrid group was 5.3 years (range, 2-11 years), compared with 4.6 years (range, 2-10 years) in the control group. Operating room (OR) time, estimated blood loss, and levels fused were collected as surrogates for surgical morbidity. Radiographic parameters were collected preoperatively, postoperatively, and at final follow-up. The Scoliosis Research Society Patient Questionnaire (SRS-22r) and Oswestry Disability Index (ODI) scores were collected for clinical outcomes. Results: Operating room time, EBL, and levels fused were significantly less in the hybrid group compared with the control group (p<.0001). The postoperative thoracic Cobb angle was similar between the hybrid and control techniques (p=.24); however, the hybrid technique showed significant improvement in the thoracolumbar/lumbar curves (p=.004) and the lumbosacral fractional curve (p<.0001). The major complication rate was less in the hybrid group compared with the control group (18{\%} vs. 39{\%}, p=.01). Clinical outcomes at final follow-up were not significantly different based on overall SRS-22r scores and ODI scores. Conclusion: The new hybrid technique demonstrates good long-term results, with less morbidity and fewer complications than traditional anteroposterior surgery select patients with thoracolumbar/lumbar scoliosis. This study received no funding. No potential conflict of interest-associated bias existed.",
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AU - Patel, Ravi

AU - Lawhorne, Thomas W.

AU - Cunningham, Matthew E.

AU - Boachie-Adjei, Oheneba

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KW - Adult idiopathic degenerative scoliosis

KW - Anterior instrumentation

KW - Anteroposterior spinal fusion

KW - Long posterior spinal instrumentation

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