Lateral Lumbar Interbody Fusion (LLIF) for the Treatment of Adult Spinal Deformity (ASD)

Study Design: A retrospective case control study.Purpose: The purpose of this study was to compare the surgical outcomes of multilevel lateral lumbar interbody fusion (LIF) and multilevel posterior lumbar interbody fusion (PLIF) in the surgical treatment of adult spinal deformity (ASD) and to evaluate the sagittal plane correction by combining LIF with posterior-column osteotomy (PCO).Overview of Literature: The surgical outcomes between multilevel LIF and multilevel PLIF in ASD patients remain unclear.Methods: We retrospectively reviewed 31 ASD patients who underwent multilevel LIF combined with PCO (LIF group, n=14) or multilevel PLIF (PLIF group, n=17) and with a minimum 2-year follow-up. In the comparison between LIF and PLIF groups, their mean age at surgery was 69.4 vs. 61.8 years while the mean follow-up period was 29.2 vs. 59.3 months. We evaluated the transition of pelvic incidence–lumbar lordosis (PI–LL) and disc angle (DA) in the LIF group, in fulcrum backward bending (FBB), after LIF and after posterior spinal fusion (PSF) with PCO. The spinopelvic radiographic parameters were compared between LIF and PLIF groups.Results: Compared with the PLIF group, the LIF group had less blood loss and comparable surgical outcomes with respect to radiographic data, health-related quality of life scores and surgical time. In the LIF group, the mean DA and PI–LL were unchanged after LIF (DA, 5.8°; PI–LL, 15°) compared with the values using FBB (DA, 4.3°; PI–LL, 15°) and improved significantly after PSF with PCO (DA, 8.1°; PI–LL, 0°).Conclusions: In the surgical treatment of ASD, multilevel LIF is less invasive than multilevel PLIF and combination of LIF and PCO would be necessary for optimal sagittal correction in patients with rigid deformity.

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Radiological outcomes of Lateral Lumbar Interbody Fusion (LIF) in Adult Spinal Deformity – A Systematic Review

Egyptian Spine Journal ◽

10.21608/esj.2021.64567.1173 ◽

2021 ◽

Vol 37 (1) ◽

pp. 2-14

Author(s):

Satish Rudrappa ◽

Ramachandran Govindasamy ◽

Venugopal Sarath Chander ◽

Akash Hosthota

Keyword(s):

Systematic Review ◽

Spinal Deformity ◽

Interbody Fusion ◽

Adult Spinal Deformity ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion

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Does Anterior Column Realignment Result in Greater Morbidity than Lateral Lumbar Interbody Fusion Alone When Treating Adult Spinal Deformity?

Neurosurgery ◽

10.1093/neuros/nyz310_335 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Adam S Kanter ◽

Robert Eastlack ◽

Juan S Uribe ◽

Richard G Fessler ◽

Khoi D Than ◽

...

Keyword(s):

Spinal Deformity ◽

Interbody Fusion ◽

Adult Spinal Deformity ◽

Lateral Approach ◽

Anterior Column ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

Inclusion Criteria ◽

Spinopelvic Parameters ◽

Lateral Lumbar Interbody Fusion

Abstract INTRODUCTION 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. METHODS Inclusion criteria were age = 18 yr, and one of the following: coronal cobb > 20°, SVA > 5 cm, PT > 20°, PI-LL > 10°. Patients were treated with circumferential MIS (cMIS) surgery or hybrid MIS surgery and had 1-year minimum follow-up. HRQOL (Oswestry Disability Index (ODI), visual analog score (VAS), SRS-22) and spinopelvic parameters were captured. 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 = .654/0.957). The groups had similar rates of prior spine surgery (48.5% vs 57.7%; P = .403), cMIS (58.7% vs 73.1%; P = .222), posterior osteotomies (43.6% vs 34.6%; P = .409), levels instrumented (7.8 vs 8; P = .895), and interbody fusion levels (3.4 vs 3.6; P = .478). Preop (PT: 23.6/26.3; P = .373, SVA: 77.6/54.6 mm; P = .151, PI-LL: 17.3/20; P = .692) and postop spinopelvic parameters were similar between groups, except for postop SVA which was higher in the LLIF group (40 mm vs 13 mm; P = .028). 1 yr PI-LL (3.8 vs 5.8; P = .555), PT (20.6 vs 22.9; P = .536), and SVA were normalized in both groups. Preop and postop 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 = .98), including neurologic (16.8% vs 15.4%; P = .859) and vascular (0% for both groups) injuries. CONCLUSION 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. Optimization of spinopelvic parameters was achieved regardless of the technique employed. Segmental radiographic changes were not specifically evaluated, but regional and global parameters were not differentially impacted when comparing ACR and LLIF impact.

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