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

Introduction: Adult 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). Aim: To evaluate the complication rate and clinical/radiological results in 22 patients treated with XLIF procedure for DS or degenerative disc disease (DDD). Material and methods: 22 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 discussion: 22 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 lt; 0.05) and back pain from 5.91 to 3.7 (P lt; 0.05). EQ 5D-3L improved from 0.29 to 0.62 (P lt; 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. Conclusions: The 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.