Abstract
We compared radiological and clinical outcomes between multilevel lateral lumbar interbody fusion (LLIF) + hybrid posterior fixation (PF) and multilevel LLIF + conventional open PF in patients with adult spinal deformity (ASD). Patients who underwent minimally invasive surgery for ASD in a single institution between 2014 and 2018 were retrospectively reviewed. Fifty-six patients (hybrid PF, 30; open PF, 26) who underwent ASD correction surgery were enrolled between 2014 and 2018. We evaluated patients’ demographics, clinical outcomes, and radiographical parameters in each group. There was significantly less estimated blood loss in the hybrid PF group (662.8 mL vs. 1088.8 mL; p = 0.012). The CRP level 7 days after surgery was significantly lower in the hybrid PF group (2.9 mg/dL vs. 4.3 mg/dL; p = 0.035). There was no significant difference between the two groups in other demographic variables, visual analog scores for back pain and leg pain, Oswestry Disability Index, coronal Cobb angle, lumbar lordosis, pelvic tilt, pelvic incidence–lumbar lordosis mismatch, and sagittal vertical axis. There was a significantly higher percentage of major complications in the open PF group (42.3% vs. 13.3%; p = 0.039). Thus, LLIF + hybrid PF for ASD corrective surgery may be comparable to LLIF + open PF in terms of clinical and radiographic outcomes.
Highlights
There was no significant difference in the age at surgery between the two groups, with a mean of 68.2 years for the hybrid posterior fixation (PF) group and 67.6 years for the open PF group
For patients with adult spinal deformity (ASD), it is widely known that improvements in the sagittal spinopelvic alignment and whole spine alignment, which are radiographic parameters, are correlated with improved clinical outcomes [13], and corrective surgeries can be conducted to primarily target the following: pelvic tilt (PT) < 20◦, pelvic incidence (PI)-LL mismatch < 20◦, and sagittal vertical axis (SVA) < 50 mm as the optimal spinopelvic alignment parameters [14]
Mummaneni et al proposed the minimally invasive evaluation and treatment for adult degenerative deformity (MiSLAT) algorithm [17], which included minimally invasive surgery (MIS) in the selection of surgical procedures for ASD. They proposed a further simplified minimally invasive spinal deformity surgery (MISDEF) algorithm based on the Scoliosis Research
Summary
Adult spinal deformity (ASD) is defined as the presence of at least one of the following: (1). Sagittal vertical axis (SVA) of ≥5 cm, (2) pelvic tilt (PT) of ≥25◦ , (3) pelvic incidence (PI)–lumbar lordosis (LL) mismatch of ≥10◦ , coronal Cobb angle of ≥20◦ , and thoracic kyphosis of ≥60◦ [1]. ASD often causes gait disturbance and difficulty in standing due to severe lower back pain, leg pain, neural deficit, gastrointestinal disorders such as gastroesophageal reflux disease, and respiratory dysfunction. Decreased lumbar lordosis and worsening of the sagittal alignment of the spine, including the pelvis, reduce health-related quality of life (HRQOL) [2]. It is expected that the prevalence of ASD will increase as the elderly population increases, and the importance of treating this disease will become greater
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
