228 - Anterior Column Reconstruction in Primary Adult Degenerative Scoliosis...

General Session: MIS - Hall F

Presented by: M. Mokawem

Author(s):

R. Lee(1), M. Mokawem(1)

(1) Royal National Orthopaedic Hospital, Spinal Surgery, Stanmore, United Kingdom

Abstract

Background: Patients with degenerative scoliosis often present with leg pain, back pain and issues with sagittal balance. Complications following open correction surgery can be high and sagittal balance correction poor using a posterior only technique. We present a case series demonstrating that multiple anterior cages inserted via a minimally invasive lateral or anterior technique is an effective way of correcting the coronal deformity and restoring sagittal balance in these patients. Additionally, it provides indirect decompression of neural structures.

Methods: Retrospective review of prospectively collected data in a single surgeon case series of 48 patients with adult degenerative scoliosis. Previous spinal fusion surgery excluded patients.

Surgery: Anterior cages inserted via a minimally invasive lateral or anterior technique (via a single or multiple stage approach).

Outcome Measures: (i) Radiographic. Pre and post-operative parameters: Lumbar lordosis (LL), Pelvic Incidence-Lumbar Lordosis mismatch (PI-LL), Sagittal Vertical Axis (SVA), Pelvic Tilt (PT) and Cobb angle. (ii) Patient reported outcome measures. Visual Analogue Scale (VAS) for Back pain, VAS for Leg pain, EuroQol- 5 Dimensions (EQ-5D), EQ-5D VAS, Oswestry Disability Index (ODI), Roland Morris Disability Score (RMD). Minimum follow-up: 6 months.

Results: 48 Adult patients with degenerative scoliosis (30 females and 18 males). Average age: 67.0yrs (54.9yrs - 83.4yrs). Positive sagittal balance in 31 patients. 42 Cases purely MIS and 6 cases hybrid with open posterior fusion. A total of 128 lateral cages were inserted with 1 level in 7 patients, 2 levels in 14 patients, 3 levels in 15 patients and 4 levels in 12 patients. Distribution of levels: L1/2- 12 cages, L2/3 - 34 cages, L3/4 - 44 cages, L4/5 - 38 cages. Average post-operative radiographic outcomes showed improvement of SVA 90.1 to 35.3mm, PI-LL 26 to 2 degrees and Cobb angle 23 to 5 degrees. Average 6 month patient reported outcome scores were: VAS back 8 to 3, VAS leg 8 to 2, EQ-5D 0.257 to 0.720, EQ-5D VAS 44 to 74, ODI 64 to 28, RMD 16 to 11. These scores were maintained in patients reaching 1 year and 2 year follow-up marks.

Conclusion: The use of minimally invasive anterior cages in primary adult degenerative scoliosis surgery is an effective surgical strategy with very good radiographic outcomes (achieving restoration of lordosis and correction of scoliosis) and very good patient reported outcomes (achieving improvement in leg and back pain).