Staged Lateral Lumbar Interbody Fusion Targeting Driver and Compensatory Structural Segments for Adult Degenerative Scoliosis: A Novel Strategy and Early Outcomes
Tianyong Wen, Liukun Xu, Peng Lu, Yang Zhang, Wei Ji, Yang Zheng, Zhicheng Zhang, Tiansheng SunABSTRACT
Objective
Traditional treatments for adult degenerative scoliosis (ADS) often rely on highly morbid long‐segment fusions. While lateral lumbar interbody fusion (LLIF) provides a minimally invasive alternative, consensus on precise surgical targets is lacking. We propose a novel strategy targeting “driver” and “compensatory structural” segments to optimize surgical outcomes.
Methods
A retrospective review of 104 ADS patients (2023–2024) compared this targeted LLIF strategy ( n = 64) to traditional posterior surgery ( n = 40). The LLIF approach utilized staged procedures focusing exclusively on segments driving the primary deformity and rigid compensatory segments. We evaluated radiographic parameters and clinical outcomes (VAS, ODI, EQ‐5D).
Results
The LLIF group achieved significant deformity correction, with the coronal major Cobb angle decreasing from 24.73° to 10.76°, alongside marked improvements in sagittal alignment. Patients exhibited progressive self‐correction of coronal balance over the 1‐year follow‐up. Clinical scores (VAS, ODI, EQ‐5D) improved significantly. Compared to the traditional group, targeted LLIF resulted in significantly shorter operative times and less blood loss, with comparable overall complication rates (16.0% vs. 20.0%), although traditional surgery achieved superior immediate radiographic correction.
Conclusion
Targeting driver and compensatory structural segments via LLIF is an effective, minimally invasive strategy for ADS. It offers substantial deformity correction, symptom relief, and progressive postoperative self‐correction while significantly reducing surgical trauma compared to traditional long‐segment fusions.