Clinical Efficacy of Unilateral Dual-channel Endoscopic Lumbar Interbody Fusion for Lumbar Spondylolisthesis with Spinal Scoliosis

Abstract

Objectives: Scoliosis associated with spondylolisthesis is a common phenomenon. Recent research has reported that scoliosis can spontaneously disappear after lumbar spinal fusion surgery. Researchers have advocated that, for scoliosis associated with vertebral slippage, surgery for the latter may be the only necessary intervention, while unnecessary surgery for scoliosis should be avoided. So we propose that minimally invasive techniques can achieve treatment effects similar to those of open surgery. Therefore, in this study, we aimed to investigate the clinical efficacy of unilateral dual-channel endoscopic lumbar interbody fusion (ULIF) for treating lumbar spondylolisthesis with spinal scoliosis.

Methods: This study retrospectively analyzed patients with lumbar spondylolisthesis and spinal scoliosis who underwent ULIF between September 2021 and September 2023. Measurements of the Cobb angle, lumbar lordosis (LL) angle, sacral slope (SS), slip percentage (SP), slip angle (SA), L1 plumb line-S1 distance (LASD), and average intervertebral height (AIH) were taken preoperatively, immediately following surgery, 3 months after surgery, and at the final follow-up. The visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) scoring systems were used to assess clinical results. The surgical efficacy was evaluated by comparing these parameters before and after surgery. Comparison of indicators within the same group was conducted using one-way repeated-measures analysis of variance or paired sample t-tests, whereas between-group differences were compared using an independent t-test.

Results: This study included 31 individuals who underwent surgery and completed follow-up. The follow-up period did not show a significant loss of corrective angles. Furthermore, the Cobb angle, SP, SA, and LASD significantly decreased after surgery, whereas the LL angle, SS, and AIH significantly increased (all p < 0.05). SP did not differ between the immediate postoperative period and the 3-month and final follow-up periods (p > 0.05). However, other parameters significantly improved during the follow-up period at all time points, except from 3 months to the final follow-up period (p > 0.05). Throughout the follow-up period, the lower back and leg pain VAS, ODI, and JOA scores considerably improved compared with the preoperative levels (p < 0.05).

Conclusion: ULIF effectively treated lumbar spondylolisthesis with scoliosis, thereby reducing the degree of slip and scoliosis. By performing surgical reduction, fusion, and fixation only on the slipped segment, ULIF also had a corrective effect on the spinal lateral curvature, thereby avoiding the need for unnecessary scoliosis surgery. Moreover, the short-term efficacy was satisfactory, but the long-term efficacy requires further study.

Keywords

Endoscopy / Lumbar vertebrae / Scoliosis / Spondylolisthesis / Treatment outcome

References

[1] KalichmanL, HunterDJ. Diagnosis and conservative management of degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17:327–335.

[2] ShakilH, IqbalZA, Al-GhadirAH. Scoliosis: review of types of curves, etiological theories and conservative treatment. J Back Musculoskelet Rehabil. 2014;27:111–115.

[3] ZhouZ, SongY, CaiQ, KongQ. Spontaneous resolution of scoliosis associated with lumbar spondylolisthesis. Spine J. 2013;13:e7–e10.

[4] FiskJR, MoeJH, WinterRB. Scoliosis, spondylolysis, and spondylolisthesis. Their relationship as reviewed in 539 patients. Spine (Phila Pa 1976). 1978;3(3):234–245.

[5] CrostelliM, MazzaO. AIS and spondylolisthesis. Eur Spine J. 2013;22(suppl 2):S172–S184.

[6] KhashabM, AlMaeen BN, ElkhalifaM. Scoliosis associated with lumbar spondylolisthesis: spontaneous resolution and seven-year follow-up. Cureus. 2020;12:e6904.

[7] DuCZ, ZhuZZ, WangY, et al. Curve characteristics and response of sciatic and Olisthesis scoliosis following L5/S1 transforaminal lumbar interbody fusion in adolescent lumbar spondylolisthesis. Neurosurgery. 2021;88:322–331.

[8] SeitsaloS, Osterman K, PoussaM. Scoliosis associated with lumbar spondylolisthesis. A clinical survey of 190 young patients. Spine (Phila Pa 1976). 1988;13(8):899–904.

[9] PetersonJB, WengerDR. Asymmetric spondylolisthesis as the cause of childhood lumbar scoliosis—an new imaging modalities help clarify the relationship? Iowa Orthop J. 2008;28:65–72.

[10] AoS, ZhengW, WuJ, TangY, ZhangC, Zhou Y, et al. Comparison of preliminary clinical outcomes between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in a tertiary hospital: is percutaneous endoscopic procedure superior to MIS-TLIF? A prospective cohort study. Int J Surg. 2020;76:136–143.

[11] Hwa EumJ, Hwa Heo D, SonSK, ParkCK. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine. 2016;24:602–607.

[12] HeoDH, ChoiWS, ParkCK, Kim JS. Minimally invasive oblique lumbar interbody fusion with spinal endoscope assistance: technical note. World Neurosurg. 2016;96:530–536.

[13] HeoDH, SonSK, EumJH, Park CK. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus. 2017;43:E8.

[14] KimSK, KangSS, HongYH, Park SW, LeeSC. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res. 2018;13:22.

[15] GatamAR, GatamL, MahadhiptaH, Ajiantoro A, LuthfiO, AprilyaD. Unilateral Biportal endoscopic lumbar interbody fusion: a technical note and an outcome comparison with the conventional minimally invasive fusion. Orthop Res Rev. 2021;13:229–239.

[16] ParkMK, ParkSA, SonSK, Park WW, ChoiSH. Correction to: clinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF): 1-year follow-up. Neurosurg Rev. 2019;42:763.

[17] DanielssonAJ, Nachemson AL. Radiologic findings and curve progression 22 years after treatment for adolescent idiopathic scoliosis: comparison of brace and surgical treatment with matching control group of straight individuals. Spine (Phila Pa 1976). 2001;26(5):516–525.

[18] WinterRB, Silverman BJ. Degenerative spondylolisthesis at the L4-L5 in a 32-year-old female with previous fusion for idiopathic scoliosis: a case report. J Orthop Surg (Hong Kong). 2003;11:202–206.

[19] GutmanG, Silvestre C, RoussoulyP. Sacral doming progression in developmental spondylolisthesis: a demonstrative case report with two different evolutions. Eur Spine J. 2014;23(Suppl 2):288–295.

[20] PneumaticosSG, EssesSI. Scoliosis associated with lumbar spondylolisthesis: a case presentation and review of the literature. Spine J. 2003;3:321–324.

[21] KawakamiM, TamakiT, AndoM, Yamada H, HashizumeH, YoshidaM. Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976). 2002;27(1):59–64.

[22] BarreyC, Roussouly P, Le HuecJC, et al. Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J. 2013;22(suppl 6):S834–S841.

[23] JacksonRP, Peterson MD, McManusAC, et al. Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients. Spine (Phila Pa 1976). 1998;23:1750–1767.

[24] Le HuecJC, Thompson W, MohsinalyY, et al. Sagittal balance of the spine. Eur Spine J. 2019;28:1889–1905.

[25] BarreyC, JundJ, NosedaO, Roussouly P. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J. 2007;16:1459–1467.

[26] KongLD, ZhangYZ, WangF, Kong FL, DingWY, ShenY. Radiographic restoration of sagittal spinopelvic alignment after posterior lumbar interbody fusion in degenerative spondylolisthesis. Clin Spine Surg. 2016;29:E87–E92.

[27] KeplerCK, RihnJA, RadcliffKE, Patel AA, AndersonDG, VaccaroAR, et al. Restoration of lordosis and disk height after single-level transforaminal lumbar interbody fusion. Orthop Surg. 2012;4:15–20.

[28] PoussaM, RemesV, LambergT, Tervahartiala P, SchlenzkaD, YrjönenT, et al. Treatment of severe spondylolisthesis in adolescence with reduction or fusion in situ: long-term clinical, radiologic, and functional outcome. Spine (Phila Pa 1976). 2006;31(5):583–590.

[29] ScheerJK, Auffinger B, WongRH, et al. Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF) for Spondylolisthesis in 282 Patients: In Situ arthrodesis versus reduction. World Neurosurg. 2015;84:108–113.

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