141. TRANSFORAMINAL LUMBAR INTERBODY FUSION (TLIF) FOR REVISION SURGERY OF THORACOLUMBAR AND LUMBAR SCOLIOSIS IN ADULTS: A RETROSPECTIVE STUDY

Abstract

Purpose of the study: Revision surgery for scoliosis in adults is a technical challenge. Indications include flat back, non-union, and syndromes adjacent to the instrumentation The purpose of this work was to evaluate the pertinence of the transforaminal lumbar interbody fusion (TLIF) method for revision surgery for scoliosis in adults.

Material and methods: In our spinal surgery unit, 23 patients underwent revision surgery for thoracolumbar and lumbar scoliosis. A unique posterior approach was used. The TLIF was performed systematically at the lumbosacral level, at the non-union when it was present, and at the level of the Smith-Petersen osteotomies, as well as the levels above and below a transpedicular osteotomy. Seventeen patients presented flat back, ten non-union, five degenerative disease distal to the instrumentation and one degeneration proximal to the instrumentation. Nine patients had several indications for surgical revision. Five transpedicular osteotomies were performed in five patients.

Results: Mean follow-up was 30 months (range 18–48). On average 2.3 levels (range 1–4) were involved in the TLIF. The fusion was extended to the sacrum in 22 patients. The mean operative time was 5h50m (range 3–8 hours). Mean blood loss was 2100ml (400–4500). Postoperative lumbar lordosis (L1S1) was 53.5°, giving an improvement of 23° copared with the preoperative lordosis. Among the postoperative complications, there was one neurological complications which recovered partially at last follow-up one case of deep infection of the operative site which require partial removal of the implants and one case of recurrent non-union. There was no loss of correction in the frontal or sagittal planes with the exception of one patient who developed an infection. None of the patients in the series required complementary anterior surgery.

Conclusion: For revision surgery of scoliosis in the adult, a circumferential arthrodeis is needed to maintain the fusion. The TLIF method has the advantage of allowing intersomatic fusion via the posterior approach alone without opening the spinal canal. We consider that the TLIF technique is an alternative to two-phase procedures for revision surgery for scoliosis in adults. This method has given a good percentage of fusion in our series with little loss of correction.