Llif in the Correction of Degenerative Scoliosis in Elderly Patients

Abstract

Objective The incidence of adult degenerative scoliosis (ADS) among individuals over 50 years old can be as high as 68%. Surgical interventions aimed at correcting the spinal deformity in elderly patients are accompanied by a high risk of complications. The use of lateral lumbar interbody fusion (LLIF) is associated with lower rates of complications when compared with open anterior or posterior fusions. Methods Ninety-three patients with ADS (23 men, 70 women) were operated at the Federal Neurosurgical Center. The average age was 63 (52 to 73 years). Results Back pain, measured according to the Visual Analogue Scale (VAS), decreased from 5.9/6 (4;8) (format – mean/median (1;3 quartile)) to 2.6/3 (1;3) points (p <0.0001). Leg pain according to the VAS decreased from 4.6/4 (3;7) to 1.4/1 (0;2) points (p < 0.0001). Functional adaptation according to the Oswestry Disability Index (ODI) improved from 47.8±17.4 to 38.5±14.5 (p < 0.0273). Pelvic tilt (PT) before the surgery was 23.9±12.2° whereas at 12 months follow-up it was 16.8±5.9° (p < 0.0001). PI-LL mismatch pre surgery was 12.1/13 (9;16)° whereas 12 months later it was 7.9/8 (6;10)° (p = 0.0002). Conclusions Restoration of local sagittal balance in ADS patients by short-segment fixation using LLIF technology leads to a statistically significant improvement in quality of life and increased functional adaptation. A lower incidence of early and late postoperative complications, less intraoperative blood loss and shorter hospital stay makes LLIF, in combination with minimally invasive transpedicular fixation, the method of choice to correct ADS in elderly patients. Level of evidence IV; Case series.

Morphometric Analysis of the Surgical Corridor in the Pre-Psoas Approach: An Mri Study in the Brazilian Population

“…Advances in surgical techniques and instruments have allowed minimally invasive surgical approaches to become a safe alternative to traditional open techniques and often the preferred choice for many spine surgeons. [1][2][3][4][5][6][7] These new minimally invasive approaches mainly include anterior intervertebral lumbar fusion (ALIF), lateral/extreme lumbar intervertebral fusion (LLIF/XLIF), and oblique intervertebral lumbar fusion (OLIF/ATP). 8 The OLIF/ATP, which uses the pre-psoas access to the lumbar spine, will be the focus of our study and was first described by Silvestre et al, in 2012.…”

Contribuição Da Eficácia Da Elastografia Na Diferenciação De Nódulos Mamários Em Uma Coorte Prospectiva De Pacientes

“…Dentre as causas que corroboram para um risco aumentado da PVPO, estão doenças crônicas como hipertensão arterial, diabetes mellitus, coagulopatias e aterosclerose, e fatores intra-operatórios como sangramentos, hipóxia e hipervolemia (CHANDRA; KUDAN, 2017;KLIMOV et. al., 2020).…”