260. How much lordosis can be restored by minimally invasive multilevel lateral lumbar interbody fusion combined with posterior column osteotomy using stiff rod (6.35 mm cobalt chrome) in adult spinal deformity surgery?

Abstract

BACKGROUND CONTEXT Pedicle subtration osteotomy (PSO) is highly effective as a method for sagittal correction in patients with adult spinal deformity, but there are issues such as surgical complexity and long-term complications. Although, recently, minimally invasive techniques have been reported to be useful for surgical treatment of adult spinal deformity, few reports have directly compared it with PSO. PURPOSE The purpose of this study was to evaluate the radiological and clinical efficacies of lateral lumbar interbody fusion (LLIF) combined with posterior column osteotomy (PCO) using stiff rod (6.35 mm Cobalt Chrome; CoCr). STUDY DESIGN/SETTING Retrospective, consecutive case review. PATIENT SAMPLE A total of 106 patients (average age 71.5 years) who were diagnosed adult spinal deformity with sagittal imbalance and followed up for more than 2 years after sagittal correction OUTCOME MEASURES Description and analysis of X-ray and clinical questionaires (Oswestry Disability Index, Visual Analogie Scale) METHODS Comparative analysis was performed on the spinopelvic parameters and clinical outcomes of patients who underwent PSO (PSO group; n=65) and the patients who underwent multilevel pre-psoas LLIF combined with PCO and open posterior spinal fusion using 6.35 mm Cobalt Chrome rod (LLIF group; n=41). RESULTS There were no differences in preoperative spinopelvic parameters between PSO group and LLIF group. Although there were no differences between the two groups in terms of postoperative SVA (-12.7 mm vs -16.5 mm), postoperative lumbar lordosis (-71.5° vs -72.6°), lumbar lordosis correction (78.0°vs 73.5°), sacral slope (46.3° vs 49.1°) and pelvic tilt (9.4° vs 7.2°), estimated blood loss was significantly lower in the LLIF group (2,824 ml vs 1,736 ml, P=0.000). No differences were observed in the clinical outcomes (Oswestry Disability Index, Visual Analog Scale), proximal junctional kyphosis, and spinopelvic parameters between the two groups 2 years after the surgery, but reoperation due to pseudarthrosis was significantly higher in the PSO group (P=0.004). CONCLUSIONS Minimally invasive multilevel LLIF combined with PCO using a stiff rod leads to better clinical and radiological outcomes as much as PSO, accompanied by fewer long-term major complications, such as pseudarthrosis and reoperation. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.