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.