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KMID : 1148120160060010007
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Journal of Advanced Spine Surgery
2016 Volume.6 No. 1 p.7 ~ p.19
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Anterolateral Versus Posterior-only Approach for the Correction of Degenerative Adult Spinal Deformity: a Matched Cohort Analysis
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Lee Chong-Suh
Park Se-Jun
Chung Sung-Soo
Lee Kyung-Joon
Park Hyun-Jun
Park Jin-Sung
Yum Tae-Hoon
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Abstract
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Purpose: Despite the increasing prevalence of spinal deformity correction using lateral lumbar interbody fusion (LLIF) for degenerative adult spinal deformity, the amount of sagittal plane correction is reported to be suboptimal. Thus, authors have performed mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segment in adjunct to LLIF to make sufficient lumbar lordosis (LL). This study is performed to demonstrate the feasibility of mini-open anterior lumbar interbody fusion (ALIF) combined with lateral lumbar interbody fusion (LLIF) followed by 2-stage posterior fixation in terms of the correction capacity and complications by comparing with a matched control group undergoing posterior-only surgery.
Materials and Methods: This study was case-control study. Thirty patients who underwent ALIF with LLIF followed by 2-stage posterior fixation (ALIF/LLIF group) for adult spinal deformity were compared to 60 patients who underwent posterior-only surgery (posterior group) and were matched according to age, sex, diagnosis, fusion length, pelvic incidence (PI), and follow-up duration. Spinopelvic parameters, hospitalization data, clinical outcomes, and complications were evaluated and compared between ALIF/LLIF and posterior groups.
Results: In the ALIF/LLIF group, interbody fusions were performed for a mean of 4.0 levels, comprising 1.6 and 2.4 levels for ALIF and LLIF, respectively. Interbody fusion in the posterior group was performed for a mean of 3.3 levels. The mean follow-up duration did not differ between two groups (16.7 mo vs. 19.2 mo, p=0.056). Postoperative LL was greater in the ALIF/LLIF than in the posterior group (52.0° vs. 40.9°, p<0.001). The reduction in the sagittal vertical axis was also greater for the ALIF/LLIF group than the posterior group (62.3 mm vs. 24.7 mm). The operation time of the ALIF/LLIF group was longer than the posterior group (11.2 hr vs. 8.6 hr, p<0.001), while estimated blood loss and red cell transfusion was less in the ALIF/LLIF group. Medical complications developed more frequently in the posterior group, while perioperative surgical complications were not different between groups. Delayed surgical complications were observed more in the posterior group. In the posterior group, there were 7 patients who experienced nonunion and rod breakage and 10 patients who experienced decompensation, while there were no such cases in the ALIF/LLIF group.
Conclusion: Mini-open ALIF combined with LLIF can restore sagittal balance more appropriately with a lower rate of complications compared with posterior-alone surgery for the correction of ASD.
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KEYWORD
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Adult spinal deformity, Anterolateral approach, Posterior-only approach, Matched corhot analysis, Sagittal balance
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