Artikel
Less-invasive surgical correction of adult degenerative scoliosis – complications and clinical outcome
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Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: Surgical correction of adult degenerative scoliosis is a technically demanding procedure with a considerable complication rate. Extensive blood loss has been identified as significant factor linked to unfavorable outcome. Less-invasive surgical technique may be useful to reduce perioperative morbidiy and improve short-term outcome.
Methods: 30 patients (age: 64–88 y) with progressive postural impairment, back pain, radiculopathy and neurogenic claudication due to degenerative scoliosis were treated by less-invasive image-guided correction (3 to 8 segments) by multisegmental TLIF and facet fusions. With a mean follow-up of 19.6 months, intraoperative blood loss, curve correction, fusion and complication rates, duration of hospitalization, incidence of hardware related problems and clinical outcome parameters were assessed using multivariate analysis.
Results: Satisfactory multiplanar correction was obtained in all patients. Mean intraoperative blood loss was 771.7±231.9ml, time to full ambulation 0.8±0.6days, and length of stay 8.2±2.9days. After 12 months, preoperative SF12v2 physical component summary scores (20.2±2.6), VAS scores (7.5±0.8) and ODI (57.2±6.9) improved to 34.6±3.9, 2.63±0.6 and 24.8±7.1, respectively. The rate of major and minor complications was 23.4% and 59.9%, respectively. 90% of patients rated treatment success as excellent, good or fair. No evidence of fusion was found in 11% of treated segments at 12 monhts.
Conclusions: Less-invasive image-guided correction of degenerative scoliosis in elderly patients with significant comorbidity yields a favorable complication profile. Significant improvements in spinal balance, pain, and functional scores mirrored expedited ambulation and early resumption of daily activities. Less-invasive techniques appear suitable to reduce periprocedural morbidity, especially in elderly patients and individuals with significant medical risk factors.