title: Lateral interbody fusion combined with open posterior surgery for adult spinal deformity.
abstract: OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed. Patients with < 6 months follow-up, prior fusion, severe sagittal imbalance (sagittal vertical axis > 200 mm or pelvic incidence-LL > 40°), and those undergoing anterior lumbar interbody fusion were excluded. Deformity correction, complications, and outcomes were compared between LIF+OP and OP-only surgery patients. RESULTS LIF+OP (n = 32) and OP-only patients (n = 60) had similar baseline features and posterior fusion levels. On average, 3.8 LIFs were performed. Patients who underwent LIF+OP had less blood loss (1129 vs 1833 ml, p = 0.016) and lower durotomy rates (0% vs 23%, p = 0.002). Patients in the LIF+OP group required less ICU care (0.7 vs 2.8 days, p < 0.001) and inpatient rehabilitation (63% vs 87%, p = 0.015). The incidence of new leg pain, numbness, or weakness was similar between groups (28% vs 22%, p = 0.609). All leg symptoms resolved within 6 months, except in 1 OP-only patient. Follow-up duration was similar (28 vs 25 months, p = 0.462). LIF+OP patients had significantly less pseudarthrosis (6% vs 27%, p = 0.026) and greater improvement in visual analog scale back pain (mean decrease 4.0 vs 1.9, p = 0.046) and Oswestry Disability Index (mean decrease 21 vs 12, p = 0.035) scores. Lumbar coronal correction was greater with LIF+OP surgery (mean [± SD] 22° ± 13° vs 14° ± 13°, p = 0.010). LL restoration was 22° ± 13°, intermediately between OP-only with facet osteotomies (11° ± 7°, p < 0.001) and pedicle subtraction osteotomy (29° ± 10°, p = 0.045). CONCLUSIONS LIF+OP is an effective strategy for ASD of moderate severity. Compared with the authors' OP-only operations, LIF+OP was associated with faster recovery, fewer complications, and greater relief of pain and disability.
authors.affiliation: Departments of Orthopaedic Surgery and.
authors.forename: Russell G
authors.initials: RG
authors.lastname: Strom
authors.affiliation: Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, South Korea; and.
authors.forename: Junseok
authors.initials: J
authors.lastname: Bae
authors.affiliation: Neurological Surgery, University of California, San Francisco, California.
authors.forename: Jun
authors.initials: J
authors.lastname: Mizutani
authors.affiliation: Department of Orthopaedic Surgery, Washington University in St. Louis, Missouri.
authors.forename: Frank
authors.initials: F
authors.lastname: Valone
authors.affiliation: Neurological Surgery, University of California, San Francisco, California.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: Departments of Orthopaedic Surgery and.
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000453:epidemiology; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013121:Spinal Curvatures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods* / Q000706:statistics & numerical data; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome
keywords: ALIF = anterior lumbar interbody fusion; ASD = adult spinal deformity; CVA = coronal vertical axis; HRQOL = health-related quality of life; ICU = intensive care unit; LIF = lateral interbody fusion; LL = lumbar lordosis; MIS = minimally invasive surgery; ODI = Oswestry Disability Index; OP = open posterior; PI = pelvic incidence; PSO = pedicle subtraction osteotomy; PT = pelvic tilt; SVA = sagittal vertical axis; TLIF = transforaminal lumbar interbody fusion; VAS = visual analog scale; XLIF; adult spinal deformity; lateral lumbar interbody fusion; open posterior approach; outcomes; sagittal correction