Asian Spine J.  2016 Dec;10(6):1023-1032. 10.4184/asj.2016.10.6.1023.

Mini-Open Anterior Lumbar Interbody Fusion Combined with Lateral Lumbar Interbody Fusion in Corrective Surgery for Adult Spinal Deformity

Affiliations
  • 1Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. sejunos@gmail.com
  • 2Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea.

Abstract

STUDY DESIGN: Prospective observational study. PURPOSE: To introduce the techniques and present the surgical outcomes of mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segments of the spine combined with lateral lumbar interbody fusion (LLIF) for the correction of adult spinal deformity OVERVIEW OF LITERATURE: Although LLIF is increasingly used to correct adult spinal deformity, the correction of sagittal plane deformity with LLIF alone is reportedly suboptimal.
METHODS
Thirty-two consecutive patients with adult spinal deformity underwent LLIF combined with mini-open ALIF at the L5-S1 or L4-S1 levels followed by 2-stage posterior fixation. ALIF was performed for a mean 1.3 levels and LLIF for a mean 2.7 levels. Then, percutaneous fixation was performed in 11 patients (percutaneous group), open correction with facetectomy with or without laminectomy in 16 (open group), and additional pedicle subtraction osteotomy (PSO) in 5 (PSO group). Spinopelvic parameters were compared preoperatively and postoperatively. Hospitalization data and clinical outcomes were recorded.
RESULTS
No major medical complications developed, and clinical outcomes improved postoperatively in all groups. The mean postoperative segmental lordosis was greater after ALIF (17.5°±5.5°) than after LLIF (8.1°±5.3°, p <0.001). Four patients (12.5%) had lumbar lordosis with a pelvic incidence of ±9° preoperatively, whereas this outcome was achieved postoperatively in 30 patients (93.8%). The total increase in lumbar lordosis was 14.7° in the percutaneous group, 35.3° in the open group, and 57.0° in the PSO group. The ranges of potential lumbar lordosis increase were estimated as 4°-25°, 23°-42°, and 45°-65°, respectively.
CONCLUSIONS
Mini-open ALIF combined with LLIF followed by posterior fixation may be a feasible technique for achieving optimal sagittal balance and reducing the necessity of more extensive surgery.

Keyword

Adult spinal deformity; Lateral lumbar interbody fusion; Anterior lumbar interbody fusion; Sagittal balance; Lumbar lordosis

MeSH Terms

Adult*
Animals
Congenital Abnormalities*
Hospitalization
Humans
Incidence
Laminectomy
Lordosis
Observational Study
Osteotomy
Prospective Studies
Spine
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