184. Comparison of stand-alone lateral lumbar interbody fusion and open laminectomy and posterolateral instrumented fusion in the treatment of adjacent segment disease following previous lumbar fusion surgery

Abstract

BACKGROUND CONTEXT Recent studies have suggested that lateral lumbar interbody fusion (LLIF) can successfully treat adjacent segment disease (ASD), however, there are no studies to date that compare LLIF with the traditional open posterolateral fusion (PLF) in this cohort. PURPOSE Compare clinical and radiographic outcomes of patients who underwent stand-alone LLIF to those who underwent PLF for symptomatic ASD. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Forty-seven consecutive patients who underwent a single- or two-level LLIF or open posterior decompression and PLF for symptomatic ASD between January 2007 and August 2016 after failure of conservative management. Exclusion criteria included: under the age of 18, follow-up of less than 24 months, presentation with adjacent level pathology that showed a spondylolisthesis greater than grade 1, active infection, active malignancy, or acute trauma. OUTCOME MEASURES Patient-reported outcomes (PRO) were collected on all patients preoperatively and postoperatively at intervals of 2 weeks, 6 weeks, 3 months, 1 year after surgery, and at the most recent postoperative visit using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS)–Back, and VAS–Leg surveys. Preoperative, immediate postoperative (day 1 or 2 after surgery) and most recent postoperative radiographs were assessed for: pelvic incidence, fusion, intervertebral disc height (average between anterior and posterior measurements of the distance between inferior end plate of the cephalad vertebral body and superior end plate of the caudal vertebral body), segmental and overall lordosis. METHODS Patients undergoing a single- or two-level LLIF or open posterior decompression and PLF for symptomatic ASD after failure of conservative management were included. Symptomatic ASD was diagnosed if back pain, neurogenic claudication, or lower extremity radiculopathy presented following a previous LF. Preoperative plain radiographs were evaluated for the presence of pathology associated with adjacent segment degeneration. RESULTS Forty-seven patients (23 LLIF, 24 PLF) met inclusion criteria. The LLIF group had significantly more male patients (p=0.028); however, there were no other differences in demographics between groups. Operative times (p CONCLUSIONS Stand-alone LLIF appears to be a safe and effective approach with substantially less perioperative morbidity, shorter length of hospitalization, acceptable complication rates, significantly better restoration of radiographic sagittal alignment parameters, and similar successful PRO compared to patients undergoing open PLF for symptomatic ASD. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.