Comparison of lateral lumbar interbody fusion (LLIF) with open versus percutaneous screw fixation for adult degenerative scoliosis

Study design: Retrospective Review Objectives: Compare clinical outcomes and radiographic correction of adult degenerative scoliosis (ADS) patients treated with lateral lumbar interbody fusion (LLIF), combined either with percutaneous (no laminectomy) versus open laminectomy/pedicle screw instrumentation. Methods: Twenty-two ADS patients undergoing combined LLIF and posterior instrumentation were divided into two groups: thirteen patients underwent LLIF with open laminectomy and posterior pedicle instrumentation (Group-1, six revision); nine patients underwent LLIF with percutaneous pedicle instrumentation (no decompression) (Group-2). Radiographs, CT/MRI, peri-operative complications, VAS, SF-12, and ODI were measured. Results: Average follow up was 22 months. In Group-1 and Group-2, respectively: Mean coronal Cobb angle corrected 12.6 degrees and 5.8 degrees; Mean regional lumbar lordosis improved 11.1 degrees and 3.8 degrees; Pelvic incidence minus lumbar lordosis mismatch corrected to within + / - 9 degrees in 46% and 0% of patients; Mean VAS improved from 5.4 to 2.8 and 6.3 to 1; Mean ODI improved 19% and 22%. Improvements were found in SF-12 PCS and MCS scores. Conclusions: Both open and percutaneous posterior techniques following LLIF significantly improved clinical outcomes. Open procedures resulted in significantly better radiographic improvements but also higher complication rates. LLIF with percutaneous posterior fixation, without decompression, should be considered part of the algorithm in select ADS patients with remaining compensatory mechanisms and understanding that greater degrees of correction may require an open, more extensive approach.