Abstract
Introduction
Posterior approach in degenerative scoliosis de novo is related to high rate of complications in elderly people. In a previous retrospective and comparative report in 2009 (French Spinal Society), Stand alone ALIF/OLIF proved a less iatrogenic procedure to relief the pain and meet patient's expectations. A prospective study including 50 patients has been performed to confirm this previous report, with at least one-year follow-up.
Material and Methods
The indications are based on a specific classification according to the biomechanism of the rotatory discogenic collapse. Therefore, two homogenic groups are compared. The details of the procedure are important with elderly people to avoid vascular complication or subsidence (preventive vertebral augmentation) due to osteoporosis. Stand alone ALIF/OLIF using a Peek cage. The cage and disk space are filled with nanoparticles of HAP. The outcomes are assessed with VAS, ODI, Kim&Kim score, standard radiography and spinogram at two, six and twelve-month follow-up periods.
Results
The two groups have specific physiopathology and epidemiology. But, outcomes are very similar after one-year follow-up. Surprisingly, it is not related to the number of disk's levels (1 to 4) operated on. According to Kim&Kim score: 30% have excellent outcome, 60% good result. VAS drops from 7/10 to 2/10 at one year. Complications (10% poor results) are mainly related to vertebral body fractures (upper endplate of L5). Posterior Vertebral augmentation was not efficient to improve the score. Symptomatic effect of sympathectomy is noted (8%) but with good acceptance. Revision rate is 6% mainly due to the persistence of a radiculopathy linked to posterior stenosis. A posterior decompression was performed after 4 months and relieved the symptoms. Radiologic fusion rate is 90% with HAP nanoparticles. It proves a low cost, less iatrogenic than BMP 2 and efficient solution in elderly people.
Conclusion
This prospective study confirms that Stand alone ALIF/OLIF is a better procedure to relieve the pain and meet patient's expectation compared with posterior instrumented surgery. Preserving posterior musculature and reshaping the anterior “lumbar arch,” Stand alone ALIF improves the sagittal balance in a physiological way. Osteoporosis required a “systematic” vertebral augmentation by anterior approach to lower subsidence or vertebral body fractures rate.