Defining the Post-Operative Progression of Degenerative Scoliosis: An Analysis of Cases without Instrument Failure

•We identify how radiographic parameters can be expected to change following TLIF.•We create a reference for surgeons to aim for in correcting spinal deformity in adults.•Non-revision patients experienced durable improvement in three key radiographic parameters.•Revision patients experienced improve...

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Bibliographic Details
Published in:	Journal of clinical neuroscience 2024-02, Vol.120, p.107-114
Main Authors:	Jha, Rohan, Chalif, Joshua I., Yearley, Alexander G., Chalif, Eric, Zaidi, Hasan A.
Format:	Article
Language:	eng
Subjects:	Adult spine deformity Aged Animals Cobb angle Complications Degenerative scoliosis Humans Kyphosis - surgery Lordosis - diagnostic imaging Lordosis - etiology Lordosis - surgery Lumbar Vertebrae - diagnostic imaging Lumbar Vertebrae - surgery Middle Aged Radiographic outcomes Retrospective Studies Scoliosis - diagnostic imaging Scoliosis - etiology Scoliosis - surgery Spinal Fusion - methods TLIF Treatment Outcome
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Summary:	•We identify how radiographic parameters can be expected to change following TLIF.•We create a reference for surgeons to aim for in correcting spinal deformity in adults.•Non-revision patients experienced durable improvement in three key radiographic parameters.•Revision patients experienced improvement post-operatively, but reverted during follow-up. The expected post-operative changes in radiographic alignment over time remain poorly defined in patients surgically treated for degenerative scoliosis without instrument failure. Here we aim to describe the optimal natural progression of radiographic degenerative scoliosis at multiple timepoints in patients treated with a transforaminal lumbar interbody fusion (TLIF). We identified an initial retrospective cohort of 114 patients treated with a TLIF for degenerative scoliosis between 2018 and 2022, with 39 patients ultimately meeting the imaging inclusion criteria. Patients who completed a primary or revision procedure with no evidence of instrument failure, proximal junctional kyphosis, or proximal junctional failure at last follow-up were included. Radiographic measurements of spinopelvic alignment were manually extracted from X-Ray scoliosis films. Thirty-nine patients (mean age 62.6 ± 8.7, mean follow-up 2.9 years), of which 23 underwent a primary TLIF (Primary) and 16 a revision procedure (Revision), were analyzed. Patients in the Primary group experienced a durable improvement in Thoracolumbar Cobb angle (-25° ± 15°), Thoracic Kyphosis (10° ± 13°), and Pelvic Incidence/lumbar lordosis mismatch (PI/LL) (-19° ± 19°) through the first year of follow-up. In the Revision group, at one year follow-up, all measures of spinopelvic alignment except PI/LL mismatch had reverted to pre-operative levels. Thoracolumbar Cobb angle decreased to a significantly greater degree in the Primary group compared to the Revision group. Primary TLIF operations without instrument failure consistently improve radiographic outcomes in three key measures through the first year. For revision procedures, there appears to be modest radiographic benefit at follow-up.
ISSN:	0967-5868 1532-2653