206. Does ACR result in greater morbidity than LLIF alone when treating adult spinal deformity?

Abstract

BACKGROUND CONTEXT Anterior column realignment (ACR) can be utilized for correction of adult spinal deformity (ASD), but the additional benefit over lateral lumbar interbody fusion (LLIF) alone is unclear. PURPOSE To evaluate the relative impact of ACR vs LLIF on clinical and radiographic outcomes, as well as complication rates, when surgically treating ASD. STUDY DESIGN/SETTING Prospective multicenter database review. PATIENT SAMPLE A total of 127 patients. OUTCOME MEASURES Oswestry Disability Index (ODI), visual analog score (VAS), SRS-22. METHODS Inclusion criteria were age ≥18 years, and one of the following: coronal cobb>20°, SVA>5cm, PT>20°, PI-LL >10°. Patients were treated with circumferential MIS (cMIS) surgery or hybrid MIS surgery, underwent LLIF (LLIF group) or ACR/LLIF (ACR group) and had 1-year minimum follow-up. RESULTS A total of 127 patients met inclusion criteria, 101 underwent LLIF and 26 had ACR. Average age and BMI were 66.3/27.7 and 67.8/27.4 (p=0.654/0.957). The groups had similar rates of prior spine surgery (48.5% vs 57.7%; p=0.403), cMIS (58.7% vs 73.1%; p=0.222), posterior osteotomies (43.6% vs 34.6%; p=0.409), levels instrumented (7.8 vs 8; p=0.895), and interbody fusion levels (3.4 vs 3.6; p=0.478). Preop and postop spinopelvic parameters were similar between groups, except for postop SVA which was higher in the LLIF group (40mm vs 13mm; p = 0.028). One year PI-LL (3.8 vs 5.8; p=0.555), PT (20.6 vs 22.9;p=0.536), and SVA were normalized in both groups. Preoperative and postoperative ODI, VAS, and SRS -22 scores were similar between groups. Complication rates between groups were similar as well (57.4% LLIF vs 57.7% ACR; p=0.98), including neurologic (16.8% vs 15.4%; p=0.859) and vascular (0% for both groups) injuries. CONCLUSIONS Use of ACR via lateral approach for correction of adult spinal deformity results in no increase in neurologic, vascular, or other overall complications rates, when compared to using LLIF alone, but is a more complex procedure and should be performed by highly experienced surgeons. Optimization of spino-pelvic parameters was achieved regardless of the technique employed. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.