Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Minimally invasive (MI) fusion and instrumentation techniques are playing a new role in the treatment of adult spinal deformity. The open pedicle subtraction osteotomy (PSO) and Smith-Petersen osteotomy (SPO) are proven segmental methods for improving regional lordosis and global sagittal parameters. Recently the MI anterior column release (ACR) was introduced as a segmental method for treating sagittal imbalance. There is a paucity of data in the literature evaluating the alternatives to PSO and SPO for sagittal balance correction.</jats:p> <jats:p>Thus, the authors conducted a preliminary retrospective radiographic review of prospectively collected data from 2009 to 2012 at a single institution. The objectives of this study were to: 1) investigate the radiographic effect of MI-ACR on spinopelvic parameters, 2) compare the radiographic effect of MI-ACR with PSO and SPO for treatment of adult spinal deformity, and 3) investigate the radiographic effect of percutaneous posterior spinal instrumentation on spinopelvic parameters when combined with MI transpsoas lateral interbody fusion (LIF) for adult spinal deformity.</jats:p></jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Patient demographics and radiographic data were collected for 36 patients (9 patients who underwent MI-ACR and 27 patients who did not undergo MI-ACR). Patients included in the study were those who had undergone at least a 2-level MI-LIF procedure; adequate preoperative and postoperative 36-inch radiographs of the scoliotic curvature; a separate second-stage procedure for the placement of posterior spinal instrumentation; and a diagnosis of degenerative scoliosis (coronal Cobb angle &gt; 10° and/or sagittal vertebral axis &gt; 5 cm). Statistical analysis was performed for normality and significance testing.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Percutaneous transpedicular spinal instrumentation did not significantly alter any of the spinopelvic parameters in either the ACR group or the non-ACR group. Lateral MI-LIF alone significantly improved coronal Cobb angle by 16°, and the fractional curve significantly improved in a subgroup treated with L5–S1 transforaminal lumbar interbody fusion. Fifteen ACRs were performed in 9 patients and resulted in significant coronal Cobb angle correction, lumbar lordosis correction of 16.5°, and sagittal vertebral axis correction of 4.8 cm per patient. Segmental analysis revealed a 12° gain in segmental lumbar lordosis and a 3.1-cm correction of the sagittal vertebral axis per ACR level treated.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The lateral MI-LIF with ACR has the ability to powerfully restore lumbar lordosis and correct sagittal imbalance. This segmental MI surgical technique boasts equivalence to SPO correction of these global radiographic parameters while simultaneously creating additional disc height and correcting coronal imbalance. Addition of posterior percutaneous instrumentation without in situ manipulation or overcorrection does not alter radiographic parameters when combined with the lateral MI-LIF.</jats:p></jats:sec>

Role of Minimally Invasive Spine Surgery in Adults with Degenerative Lumbar Scoliosis: A Narrative Review

“…Although the definitive comparative results about superiority of MIS methods over open techniques have not become clear so far, most literature reports agree with this theory that complication rates, surgery time and blood loss in MIS methods were found to be lower, and ambulation after surgery and return to work happens earlier than those in open procedures [65][66][67][68]. The advance of novel procedures leads to reduce surgery time and attain faster recovery through decreasing surgery complications [68,69].…”

“…The advance of novel procedures leads to reduce surgery time and attain faster recovery through decreasing surgery complications [68,69]. Lumbar interbody fusion (LIF) is a recognized management for handling a variety of spinal complaints including degenerative diseases, infections, neoplasia and trauma [65]. LIF includes placement of an implant (cage or graft) inside the intervertebral space once discectomy and endplate preparation have been done.…”

“…Surgical challenges are mainly reestablishment of global spinal alignment, adequate decompression and successful fusion with less complications [62][63][64][65].…”

Editorial: Dynamic stabilization

“…7 Many of these procedures were greeted with substantial initial enthusiasm, but longerterm evaluation has tempered the early excitement, particularly in cases with rigid or more complex adult deformity.…”

Trends in Nonoperative Treatment Modalities Prior to Cervical Surgery and Impact on Patient-Derived Outcomes: Two-Year Analysis of 1522 Patients From the Prospective Spine Treatment Outcome Study

“…1 Nonoperative treatment has been shown to provide some benefits to these patients, but studies have been limited by small sample sizes, minimal follow-up data, and lack of control groups. [2][3][4][5][6][7] Additionally, these studies examined the immediate and short-term effects of these interventions without long-term outcome data for patients who eventually undergo surgery. For example, Manchikanti et al 8 performed a randomized study in which patients with chronic axial neck and radicular pain, attributed to cervical disc herniations, received cervical epidural injections with local anesthetic with or without corticosteroids.…”