Minimally Invasive Multilevel Lateral Lumbar Interbody Fusion with Posterior Column Osteotomy Compared with Pedicle Subtraction Osteotomy for Adult Spinal Deformity

BACKGROUND CONTEXT:

Pedicle subtraction osteotomy (PSO) is highly effective as a sagittal correction approach in patients with adult spinal deformity, but relevant issues such as surgical complexity and long-term complications limit its applicability. Recently, minimally invasive techniques have been reported to be useful for surgical treatment of adult spinal deformity; however, few reports have directly compared these techniques with PSO.

PURPOSE:

The purpose of this study was to evaluate the radiological and clinical efficacies of oblique lateral interbody fusion (OLIF) with posterior column osteotomy (PCO) using stiff rods (6.35-mm cobalt chrome [CoCr]).

STUDY DESIGN:

Retrospective comparative study.

PATIENT SAMPLE:

One-hundred six patients (average age 71.3 years) diagnosed with adult spinal deformity presenting with sagittal imbalance for whom follow-up of over 2 years after sagittal correction (between 2013 and 2017) was available.

OUTCOME MEASURES:

Description and analysis of X-ray, computed tomography (CT) scans, operative time, estimated blood loss, and clinical outcomes (Oswestry Disability Index [ODI] and Visual Analog Scale [VAS]).

METHODS:

A comparative analysis was performed evaluating spinopelvic parameters and clinical outcomes including the ODI, VAS, and complications in patients who underwent PSO (PSO group; n=65) or multilevel pre-psoas OLIF combined with PCO and open posterior spinal fusion using 6.35-mm CoCr rods (OLIF group; n=41). The authors have no conflicts of interest to disclose.

RESULTS:

There were no differences in preoperative spinopelvic parameters between the PSO and OLIF groups. Although no differences were observed between the two groups in terms of postoperative SVA (-12.66 mm vs. -16.44 mm), postoperative lumbar lordosis (-71.46° vs. -72.55°), lumbar lordosis correction (77.96° vs 73.54°), or postoperative pelvic tilt (9.35° vs 7.17°), the estimated blood loss was significantly lower in the OLIF group (2824 mL vs. 1736 mL, p <.05). No differences were observed in clinical outcomes (ODI, VAS, and clinical complications), proximal junctional kyphosis, and spinopelvic parameters between the two groups 2 years after surgery. However, pseudarthrosis during the follow-up period, including rod fracture, occurred less frequently in the OLIF group compared to that in the PSO group (p <.05). OLIF was performed from the T12-L1 to L5-S1 regions (124 segments), with an average of 3 segments per patient. The CT scans immediately after surgery showed an average segmental correction of -18° and 12.9% (16 segments) of 124 segments showed a correction angle of >30°.

CONCLUSIONS:

Multilevel OLIF with PCO using a stiff rod to treat severe sagittal imbalance resulted in similar levels of sagittal balance and lordosis correction as obtained by PSO. Multilevel OLIF with PCO using a stiff rod can be an effective alternative to PSO for patients with severe sagittal imbalance.

 2019 Dec 11. pii: S1529-9430(19)31112-X. doi: 10.1016/j.spinee.2019.12.001. [Epub ahead of print]