Abstract
This study examined the ability of the extreme lateral interbody fusion (XLIF) procedure to restore coronal and sagittal alignments for patients with adult spinal deformity (ASD) using computed tomography multiplanar reconstruction (CT-MPR). Thirty-eight patients with ASD undergoing correction and fixation with XLIF at 114 levels were studied. The coronal segmental Cobb angle, coronal regional Cobb angle (L1-5), sagittal segmental Cobb angle, sagittal regional Cobb angle (L1-5), intervertebral disc height and, vertebral body rotation (VBR) were measured before and after of XLIF surgery using CT-MPR. The mean sagittal segmental Cobb angle, the coronal segmental Cobb angle and VBR were corrected from 5.0° to 9.0°, from 6.3° to 4.3° and from 12.2° to 10.8°, respectively. The mean of the intervertebral disc heights increased significantly from 6.0 mm to 10.4 mm postoperatively. Although increases in coronal segmental Cobb, sagittal segmental Cobb, and intervertebral disc height at each level were significant, there were no significant differences in each parameter acquired by spine levels. The results also showed that it was difficult for L4/5 level to obtain the most postoperative coronal Cobb, sagittal Cobb and intervertebral disc height. This study evaluated the alignment improvement effect of stand-alone XLIF in ASD patients using CT-MPR. For the lower lumbar spine, it is difficult to obtain a lordosis more than 10 degrees with stand-alone XLIF for correcting ASD. Therefore, it is thought that correction such as osteotomy or compression technique to the posterior fusion may be necessary during the 2nd stage surgery.
Highlights
Adult spinal deformity (ASD) is defined as an angular deformity presenting after skeletal maturity, and can be divided into coronal, sagittal, and mixed[1]
The purpose of this study is to evaluate the spinal alignments of adult spinal deformity (ASD) patients treated by XLIF alone using computed tomography multiplanar reconstruction (CT-MPR) immediately after the first stage of surgery
The mean preoperative regional lumbar lordosis angle increased from 27.0° to 36.0°
Summary
Adult spinal deformity (ASD) is defined as an angular deformity presenting after skeletal maturity, and can be divided into coronal (scoliosis), sagittal (kyphosis), and mixed[1]. More rigid and severe deformities may need a combined anterior-posterior approach or a posterior three-column reconstruction technique to obtain correction of spinal alignment. The extreme lateral interbody fusion (XLIF) technique, which uses a transpsoas retroperitoneal approach, has been popularized as a minimally invasive alternative surgical option for anterior column reconstruction and arthrodesis[7]. Multicenter studies on the XLIF procedure have reported improvements in coronal segmental angles, segmental lordosis, and disc height[11,12,13]. It has been reported that significant improvements in sagittal and coronal alignments can be obtained in correction surgery for ASD patients by using a two-stage combined approach[15]. The purpose of this study is to evaluate the spinal alignments of ASD patients treated by XLIF alone using computed tomography multiplanar reconstruction (CT-MPR) immediately after the first stage of surgery
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