Do the number of TLIF levels correlate with complications or long-term outcomes in degenerative scoliosis?
2016
Summary
Eighty-one patients with degenerative lumbar scoliosis underwent posterior instrumented fusion with TLIF from 0-3 levels, and were prospectively followed an average 5 years to determine differences in complications, clinical outcomes, and radiographic alignment based on the number of TLIFs used. Long-term, all patients had significantly improved VAS, Oswestry, lumbar lordosis (T12-S1, L2-S1), sagittal balance, without difference based on the number of TLIFs. Complications were similar. A larger study is required to determine if subtle differences in sagittal alignment are significant.
Hypothesis
Two or 3 TLIF levels in degenerative lumbar scoliosis (DLS) have fewer better long-term sagittal alignment and fewer revision surgeries, but similar complications and clinical outcomes compared to 0-1 TLIF levels.
Design
Prospective nonrandomized comparison of consecutive DLS patients long-term after surgery using 0, 1, 2, and 3 TLIFs
Introduction
TLIF can provide enhanced lordosis and arthrodesis in DLS. Potential long-term improvements may be possible by increasing the number of TLIF’s used.
Methods
Multi-surgeon longitudinal database of complications, clinical and radiographic outcomes after Ponte osteotomies and instrumented fusion (PSF) of at least 6 levels for DLS from 2004-2014. All were fused to S1. Excluded: 3-column osteotomies, anterior and lateral fusions.
Results
Follow-up averaged 59 months (24-121mo) for 81 patients; age 68yrs (50-85yrs); 19 (23%) were revisions; Smokers-10. PSF averaged 8.4 levels (6-16). Based on TLIF number, there was no difference in PI, or pre-op lordosis, sagittal balance, or disc angles L2-S1. Long-term there was no difference in lordosis and sagittal balance based on TLIF number (p=0.09); no difference in infection (2), nonunion(11), or revision surgery(18). Individual disc spaces L3-S1 maintained similar long-term angles in the 0-TLIF and 3 TLIF groups: L3-4(-3°), L4-5(-10°), L5-S1 (-13°). VAS, ODI, pain med use were similar pre-op and improved with surgery for all groups (p<0.01), with pre-op scores best predicting long-term scores (p=.004).
Conclusions
Using current techniques in DLS surgery, there are no differences in long-term outcomes based on the number of TLIFs used. A larger study is needed to identify small radiographic differences, if they exist.
| 0 TLIFs | 1 TLIFs | 2 TLIFs | 3 TLIFs | TOTAL | |
|---|---|---|---|---|---|
| Patients | 14 | 23 | 28 | 26 | 81 |
| Follow-up (mo) | 43 | 38 | 64 | 79 | 59 |
| Age | 69 | 67 | 66 | 68 | 68 |
| PSF levels | 8.8 | 9.4 | 8.2 | 7.7 | 8.4 |
| PI° | 57 | 56 | 55 | 52 | 55 |
| T12-S1° pre | -33 | -39 | -37 | -37 | -37 |
| latest | -48 | -47 | -49 | -49 | -49 |
| L2-S1° pre | -35 | -41 | -41 | -38 | -39 |
| latest | -44 | -44 | -47 | -47 | -46 |
| SVA cm pre | 8.6 | 5.3 | 4.4 | 6.0 | 5.8 |
| latest | 7.7 | 4.9 | 2.8 | 4.5 | 4.6 |
| VAS pre | 6.7 | 7.0 | 6.4 | 6.0 | 6.5 |
| latest | 4.0 | 4.0 | 2.8 | 3.7 | 3.0 |
| ODI pre | 45 | 48 | 46 | 47 | 46 |
| latest | 31 | 28 | 25 | 31 | 26 |
| Nonunion | 2 | 6 | 1 | 2 | 11 |
| Revision surg | 2 | 7 | 3 | 6 | 18 |