Staged Lateral Lumbar Interbody Fusion Targeting Driver and Compensatory Structural Segments for Adult Degenerative Scoliosis: A Novel Strategy and Early Outcomes

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.