Multisegment TLIF combined with Ponte osteotomy provides better QoL in degenerative lumbar scoliosis patients

Hao Qiu et al conducted a study to evaluate the long-term clinical outcomes of degenerative lumbar scoliosis (DLS) with the administration of multisegment transforaminal lumbar interbody fusion (TLIF) combined with Ponte osteotomy long-level fixation fusion, as well as to identify the factors affecting health-related quality of life (HRQOL).Their work followed the Declaration of Helsinki and was approved by the ethics committee of Xinqiao Hospital of Army Medical University. The study has been published in ‘International Orthopaedics’ journal.

TLIF was performed at selected levels in the presence of disc herniation, lumbar stenosis, lateral listhesis or rotatory subluxation, and dynamic segmental instability. Additionally, TLIF was unilaterally performed for intervertebral release to maximize the mobility of the deformed segments. An interbody cage was inserted at the narrowest site of the asymmetric disc to restore the disc height.

Ponte osteotomy was performed at apical levels of kyphosis and lateral listhesis or at the rotatory subluxation segment with TLIF. The rod was contoured after decompression and the extensive release of the anterior osteophyte segments. The convex side of the rod was set first, and a derotation manoeuvre and compression were used to restore LL and to realign the spine. Subsequently, the rod derotation technique and distraction on the concave side were carefully performed to correct the lumbar scoliosis. Finally, an interlaminar bone graft was performed at all instrumented levels via the removal of the facet joint cartilage and lamina cortex.

The authors conducted a retrospective single-centre study involving comprehensive clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) outcomes, and Scoliosis Research Society (SRS-22) questionnaire were recorded to assess HRQOL. A correlation analysis was performed to determine the association between HRQOL and radiographic parameters.

Key findings of the study were:

• A total of 41 consecutive patients (15 males and 26 females) with a mean age of 63.0±8.2 years (range: 50–78 years) met the inclusion criteria with a follow-up of 8.62±1.20 years (range: approximately 5.11–10.83 years).

• All of the patients presented with back pain, 30 patients presented with radiculopathy, and 22 patients presented with claudication.

• 28 of 41 (68.3%) patients had two or more medical comorbidities, including osteoporosis (26/41), diabetes mellitus (15/41), and hypertension (14/41).

• Factors associated with HRQOL were significantly improved post-operation.

• Global sagittal parameters, including the sagittal vertebral axis (SVA) and T1 pelvic angle (TPA), and local parameters, including apical vertebral translation (AVT) and apical vertebral rotation (AVR), were significantly improved at the last follow-up.

• Significantly strong correlations between each clinical and radiographic parameter were demonstrated. Moreover, a multiple linear regression analysis demonstrated that the differences in AVT and AVR were significantly correlated with the difference in lumbar lordosis (LL), which was significantly correlated with the differences in SVA and TPA.

The authors concluded that – “Surgical treatment of DLS with multisegment TLIF accompanied by Ponte osteotomy and long-level fixations improved the quality of life of patients with a long-term effect. This combination treatment targeting stenosis, instability, and ridged deformity is coupled with few complications. AVR correction is an important factor for LL restoration that significantly correlates with improvements in the sagittal balance parameters SVA and TPA, which are key factors to guarantee good HRQOL.

Further reading:

Multisegment transforaminal lumbar interbody fusion (TLIF) combined with Ponte osteotomy in degenerative lumbar scoliosis (DLS) surgery: a minimum of five years’ follow up Hao Qiu, Tong wei Chu et al International Orthopaedics (2022) 46:2897–2906 https://doi.org/10.1007/s00264-022-05572-1