Stand-alone XLIF: 22 consecutive patients with degenerative scoliosis and foraminal stenosis in a 2-year follow-up

IntroductionAdult thoracolumbar degeneration is an increasing challenge in the aging population. With age the progressive degeneration of the discs leads to an asymmetric collapse and a thoracolumbar coronal plane deformity, a degenerative scoliosis (DS).AimTo evaluate the complication rate and clinical/radiological results in 22 patients treated with XLIF procedure for DS or degenerative disc disease (DDD).Material and methods22 consecutive patients with DS underwent surgery with the XLIF stand-alone procedure, with follow-up of 24 months. Clinical outcome scores were collected. Complications were recorded.Results and discussion22 patients, mean age of 65 years (48–81), underwent surgery on 49 levels (1–4) between L1 and L5. VAS for leg pain improved from 5.94 to 3.5 (P < 0.05) and back pain from 5.91 to 3.7 (P < 0.05). EQ 5D-3L improved from 0.29 to 0.62 (P < 0.05). Seven patients (31.8%) underwent revision surgery. Fusion was achieved in 53% (25/49) at 1-year follow-up. Anterior thigh pain was reported in 12 patients postoperatively, and in 2 patients at 1-year follow-up.ConclusionsThe XLIF stand-alone procedure improves clinical outcome scores significantly after 1- and 2-year follow-up, with a 31.8% revision rate. Due to the high revision rate we recommend supplementary posterior instrumentation, to achieve a higher fusion rate. When considering XLIF-stand-alone procedure for DS or DDD without supplemental posterior instrumentation, only single-level disease should be advised, taking sagittal parameters into account.