General Session: Adult Spinal Deformity-2

Presented by: C-S. Lee - View Audio/Video Presentation (Members Only)

Author(s):

C-S. Lee (1), S-J Park(1), S-S. Chung(1), J-H. Kim(1), J-S. Kim(1)

(1) Samsung Medical Center, Sungkyunkwan University, School of medicine, Orthopedic Surgery, Seoul, Korea, Republic of

Abstract

Background Context: Although spinal deformity correction using LLIF has been used increasingly, the amount of sagittal plane correction was relatively suboptimal. Thus, authors have performed mini-open ALIF at the most caudal segment in adjunct to LLIF to make sufficient LL.

Purpose: To demonstrate the feasibility of mini-open anterior lumbar interbody fusion (ALIF) combined with lateral lumbar interbody fusion (LLIF) followed by 2-stage posterior fixation regarding the correction capacity and complications by comparing with matched control group undergoing posterior-only surgery.

Study Design/Setting: Case-control study.

Patient Sample: Thirty patients who underwent ALIF with LLIF followed by 2-stage posterior fixation (ALIF/LLIF group) for adult spinal deformity were matched with 60 patients who underwent posterior-only surgery (posterior group) with respect to age, sex, diagnosis, fusion length, and pelvic incidence (PI).

Outcome Measures: Spinopelvic parameters, hospitalization data, clinical outcomes, and complications were evaluated.

Results: In ALIF/LLIF group, interbody fusions were performed for mean 4.0 levels with 1.6 for ALIF and 2.4 levels for LLIF. Interbody fusion in posterior group was performed in mean 3.3 levels. Mean follow-up duration did not differ between two groups (16.7 mo vs. 19.2 mo, p=0.056). Postoperatively LL was greater in ALIF/LLIF than in posterior group (52.0° vs. 40.9°, p< 0.001). Sagittal vertical axis was reduced more in ALIF/LLIF than posterior group (-62.3mm vs. 24.7mm). Operation time of ALIF/LLIF was longer than posterior group (11.2 hr vs. 8.6 hr, p< 0.001). Estimated blood loss and red cell transfusion was less in ALIF/LLIF group. Medical complications developed more frequently in posterior group. Perioperative surgical complications did not differ. However, delayed surgical complications were observed more in posterior group. Nonunion and rod breakage developed in 7 and decompensation in 10 patients in posterior group, while no such patients in ALIF/LLIF group.

Conclusion: Through mini-open ALIF combined with LLIF followed by posterior fixation, the sagittal balance can be restored more appropriately with fewer complication rates, compared with posterior-alone surgery for the correction of adult spinal deformity.