287 - Sagittal Alignment Correction Following Minimally Invasive Lateral Fus...

#287 Sagittal Alignment Correction Following Minimally Invasive Lateral Fusion with Hyperlordotic Cages

Oral Posters: MIS

Presented by: L. Pimenta


L. Pimenta (1), (2)
R. Jensen (1)
L. Marchi (1)
L. Oliveira (1)
C. Castro (1)
E. Coutinho (1)
T. Coutinho (1)
R. Amaral (1)

(1) Instituto de Patologia da Coluna, São Paulo, Brazil
(2) UCSD, Neurosurgery, San Diego, CA, USA


Purpose: The purpose of this paper is to present a lateral retroperitoneal minimally invasive option for the treatment of iatrogenic or degenerative sagittal imbalance.

Methods: A prospective, non-randomized, single center study with up to six-year follow-up. 17 patients, mean age 69.6 y/o (51-87, range). Lateral, A-P, flexion-extension X-rays, neurological examination and clinical outcome assessments using ODI and VAS scores were collected. The lateral approach was done through the retroperitoneal space for thoracolumbar access. For anterior elongation interbody or expandable cages were used. The operated levels ranged from four to seven levels, including T10-T11 to L4-L5.

Results: No intraoperative complications occurred. Average surgical duration was 145 minutes and mean blood loss, 217cc. 10 patients underwent four levels of fusion; two patients had five levels and two patients were fused in seven levels. Three patients underwent a thoracolumbar corpectomy procedure besides interbody cages and percutaneous pedicle screws. The other patients were kept standalone. Clinical outcomes improved significantly in the postoperative evaluations. Sagittal alignments improved from average 17.1 degrees at pre-op to 37.4 degrees at last follow up. Mean SVA, sacral slope and pelvic tilt parameters also had a beneficial gain right after surgery and were maintained at the following visit points.

Conclusions: Using the lateral retroperitoneal minimal invasive approach we were able to treat long thoracolumbar deformities in a minimal invasive way targeting the pain, improving spinopelvic balance. This work also shows reasonable sagittal correction in addition to a successful clinical improvement in a long term follow up study using the minimal invasive lateral approach.

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