Surgical strategy and clinical outcomes in degenerative lumbar scoliosis with type C coronal imbalance
10.3760/cma.j.issn.0253-2352.2019.20.002
- VernacularTitle: 伴有C型冠状面失平衡退变性腰椎侧凸畸形的手术策略及其临床疗效
- Author:
Benlong SHI
1
;
Dun LIU
;
Zhen LIU
;
Zezhang ZHU
;
Xu SUN
;
Bin WANG
;
Yong QIU
Author Information
1. Department of Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
- Publication Type:Journal Article
- Keywords:
Adult;
Lumbar vertebrae;
Intervertebral disc degeneration;
Scoliosis;
Spinal fusion
- From:
Chinese Journal of Orthopaedics
2019;39(20):1232-1238
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To illustrate the surgical strategy of sequential correction in degenerative lumbar scoliosis (DLS) with type C coronal imbalance, and to evaluate the clinical outcomes and advances of sequential correction technique.
Methods:Twelve patients (2 males and 10 females) applying sequential correction technique from January 2015 to August 2017 were retrospectively reviewed. The ages of the cohort ranged 48-74 years and the average value was 52.3±8.4 years. The sequential correction technique was mainly applied in 3 steps: correction of local kyphoscoliosis with satellite rod on convex side of lumbar spine; correction of lumbosacral curve with L 4-S1 Intervertebral fusion and satellite rod on convex side of lumbosacral spine; correction of global deformity with bilateral long rods. The coronal parameters including Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL), and the sagittal parameters including global kyphosis (GK) and sagittal vertical axis (SVA) were assessed at pre-operation, post-operationand last follow-up. The quality of life was evaluated using SF-36 questionnaire, and paired t test was used for the statistical analysis.
Results:The average follow-up period was 16.7±4.8 months. The Cobb angles at pre-operation and post-operation were 59.6°±18.7° and 25.6°±12.4° (t=3.705, P<0.001), respectively. At last follow-up, the average Cobb angle was 27.5°±13.0°, and there was no significant loss of correction (t=0.366, P=0.718). Post-operative C7PL-CSVL changed from 48.5±17.2 mm to 9.7±4.3 mm (t=5.842, P<0.001), of which the average value was 10.1±4.5 mm at last follow-up (t=0.223, P=0.826). At post-operation, 11 patients were with type A coronal imbalance, and 1 patient was still with type C coronal imbalance. The scores of bodily pain, general health, and social functioning were 8.4±1.9, 78.1±9.4 and 76.7±8.4 at pre-operation, 10.2±2.0 (t=2.260, P=0.034) , 89.5±7.6 (t=3.267, P=0.004) and 84.5±9.3 (t=2.156, P=0.042) at post-operation. In addition, there was no implant-related complications during follow-up.
Conclusion:The sequential correction technique could be well used in adult degenerative lumbar scoliosis patients with type C coronal imbalance, which can simplify the surgical procedure, decrease the rates of post-operative coronal imbalance, and obtain rigid internal fixation.
