Multilevel TLIF for Spinal Deformity

Abstract

Adult spinal deformity (ASD) refers to an abnormal spinal curvature in the coronal, axial, and sagittal plane in adult patients. Most ASDs are de novo degenerative deformities that are caused by asymmetric disc and facet degeneration or osteoporotic spine insufficiency fracture [20]. Recent publications have indicated that the prevalence of any radiographic evidence of ASD can be as high as 60 % in adults older than 60 years of age [19, 24] and symptomatic scoliosis is seen in 6–30 % of the elderly population. Patients with ASD most commonly seek treatment due to pain and disability from the deformity and its associated disc degeneration, spinal stenosis, nerve roots compression, lateral listhesis, spondylolisthesis, and the overall loss of spinopelvic balance. Most symptomatic ASD patients are initially treated with conservative measures such as physical therapy, nonsteroidal anti-inflammatory medication, and narcotic analgesics. When conservative treatment fails, operative procedures aiming to decompress lumbar nerve roots and the thecal sac stabilize unstable motion segments, reestablish global spinal balance in all planes, and prevent deformity progression are indicated.