Transforaminal Lumbar Interbody Fusion Versus Anterior Lumbar Interbody Fusion as an Adjunct to Posterior Instrumented Correction of Degenerative Lumbar Scoliosis

Study Design. Prospective, nonrandomized consecutive single surgeon series. Objective. To compare the clinical and radiographic outcomes in degenerative lumbar scoliosis (DLS) patients treated with posterior instrumented correction and fusion with additional anterior lumbar interbody fusion (ALIF) versus transforaminal lumbar interbody fusion (TLIF) to help define whether anterior surgery should be routinely required in treating DLS. Summary of Background Data. The benefits of interbody support in promoting postoperative stability and arthrodesis are well established. Whether the interbody fusion is better performed from an anterior or posterior approach has not been studied for patients undergoing surgical correction for DLS. Methods. Forty consecutive patients with DLS, stenosis, and olisthesis underwent posterior instrumented reduction/ arthrodesis at average 7 levels (range: 4-9 levels). Additional ALIF was performed in 20 patients, TLIF in the other 20. Follow-up averaged 38 months (24-68 months). Oswestry Disability Index (ODI), visual analog pain scores (VAS) were evaluated preoperative, 1 and 2 years postoperative. Radiograph measurements included the scoliosis, T12 to S1 lordosis, coronal and sagittal balance, and pelvic incidence. CT evaluation of the fusion integrity was performed after 1 year. Results. The ALIF group complications included 4 nonunions, 5 adjacent level fractures, 5 adjacent degeneration, 3 infections, and 1 footdrop. Revision surgery was performed in 8 of 20. Medical complications included 2 nonfatal pulmonary embolus, 1 ileus requiring colostomy, and 1 stroke. TLIF group complications included 3 adjacent segment degeneration, 2 adjacent fractures, 2 nonunions, and 1 infection and transient footdrop. Two of 20 required revision surgery. VAS and ODI improvements for both groups showed significant improvement from preoperative (P < 0.0019) but were not different. Deformity correction was also similar (70%) between ALIF and TLIF groups. Conclusion. With current deformity correction techniques, both ALIF and TLIF are effective in DLS surgery. Anterior surgery is not routinely required to treat all cases of DLS.