Comparison of Lateral Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion as Corrective Surgery for Patients with Adult Spinal Deformity—A Propensity Score Matching Analysis

Abstract

Lateral lumbar interbody fusion (LLIF) is increasingly performed as corrective surgery for patients with adult spinal deformity (ASD). This paper compares the surgical results of LLIF and conventional posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) in ASD using a propensity score matching analysis. We retrospectively reviewed patients with ASD who received LLIF and PLIF/TLIF, and investigated patients’ backgrounds, radiographic parameters, and complications. The propensity scores were calculated from patients’ characteristics, including radiographic parameters and preoperative comorbidities, and one–to-one matching was performed. Propensity score matching produced 21 matched pairs of patients who underwent LLIF and PLIF/TLIF. All radiographic parameters significantly improved in both groups at the final follow-up compared with those of the preoperative period. The comparison between both groups demonstrated no significant difference in terms of postoperative pelvic tilt, lumbar lordosis (LL), or pelvic incidence–LL at the final follow-up. However, the sagittal vertical axis tended to be smaller in the LLIF at the final follow-up. Overall, perioperative and late complications were comparable in both procedures. However, LLIF procedures demonstrated significantly less intraoperative blood loss and a smaller incidence of postoperative epidural hematoma compared with PLIF/TLIF procedures in patients with ASD.

What Are the Benefits of Lateral Lumbar Interbody Fusion on the Treatment of Adult Spinal Deformity: A Systematic Review and Meta-Analysis Deformity

“…EBL is 1 of the main factors to assess surgical invasiveness. 34 In the current study, the EBL was 1862.57 ± 1386.69 mL in the only-PSF group, an approximate degree of blood loss correlated with an increased perioperative complication rate in spinal fusion. 28 However, the EBL was 1095.49 ± 736.13 mL in the LLIF+PSF group, demonstrating a reduction in EBL of 719.99 mL compared with the only-PSF group.…”

“…Eventually, 10 studies were included in this systematic review and meta-analysis (Figure 1). 25-34

Figure 1.Flow diagram depicting the literature review, search strategy, and selection process.

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“…These advantages may facilitate LLIF to maintain the disc and neural foramina height, and prevent subsidence and subsequent loss of deformity correction. 7,31,34…”

“…These advantages may facilitate LLIF to maintain the disc and neural foramina height, and prevent subsidence and subsequent loss of deformity correction. 7,31,34 Surgical Invasiveness. Complications after spinal surgery increase with age and surgical invasiveness, and most patients who undergo surgery for ASD are in their 60s to 70s.…”

“…Eventually, 10 studies were included in this systematic review and meta-analysis (Figure 1). [25][26][27][28][29][30][31][32][33][34]…”