Transforaminal Versus Anterior Lumbar Interbody Fusion in Long Deformity Constructs

Dorward, Ian G.; Lenke, Lawrence G.; Bridwell, Keith H.; O'Leary, Patrick; Stoker, Geoffrey E.; Pahys, Joshua M.; Kang, Matthew M.; Sides, Brenda; Koester, Linda A.

doi:10.1097/brs.0b013e31828d6ca3

Cited by 111 publications

(63 citation statements)

References 51 publications

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“…Despite this finding, relative to additional interbody support from a posterior-based approach (TLIF and PLIF), combined anterior/posterior approaches are associated with longer hospital stays and increased blood loss and surgical time, 32 , 33 which can be associated with greater risk of complications. 34 DeWald et al reviewed adult HGS patients and recommended in situ posterior fusion with instrumentation from L4 to S1 with consideration for partial reduction and vertebrectomy.…”

Section: Hgs In Adolescentsmentioning

confidence: 74%

Surgical Treatment Strategies for High-Grade Spondylolisthesis: A Systematic Review

et al. 2015

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Background HGS is a severe deformity most commonly affecting L5-S1 vertebral segment. Treatment available for HGS includes a range of different surgical options: full or partial reduction of translation and/or abnormal alignment and in situ fusion with or without decompression. Various instrumented or non-instrumented constructs are available, and surgical approach varies from anterior/posterior to combined depending on surgeon preference and experience. The aim of this systematic review was to review the literature on lumbosacral high-grade spondylolisthesis (HGS), identify patients at risk for progression to higher-grade slip and evaluate various surgical strategies to report on complications and radiographic and clinical outcomes.

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Section: Hgs In Adolescentsmentioning

confidence: 74%

Surgical Treatment Strategies for High-Grade Spondylolisthesis: A Systematic Review

et al. 2015

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“…These interbody fusion techniques are associated with high fusion rates however need to be balanced against the increased level of invasiveness and complications that can be encountered with these techniques. The anterior retroperitoneal approach for anterior lumbar interbody fusion (ALIF) carries an increased risk of vascular and visceral injures 1–6 . The minimally invasive lateral transpsoas interbody fusion (LIF) has a lower incidence of vascular injuries but maybe associated with a higher neuropraxia rate related to retraction of the lumbar plexus.…”

Section: Introductionmentioning

confidence: 99%

“…1,7–10 . The circumferential surgery has a very high arthrodesis rate and can allow extension to the pelvis which may limit the degeneration of distal unfused segments 6,11 . Clinical studies have demonstrated that interbody fusion grafts are associated with high fusion rates and improvement in sagittal balance 3–6,8–10 .…”

Section: Introductionmentioning

confidence: 99%

Sagittal Balance and Spinopelvic Parameters After Lateral Lumbar Interbody Fusion for Degenerative Scoliosis

Baghdadi

Larson

Dekutoski

et al. 2014

Spine

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Study Design Retrospective matched–cohort analysis. Objective To evaluate the change in radiographic parameters in patients undergoing interbody fusion and posterior instrumentation compared to posterior spine fusion alone (PSF) for degenerative scoliosis. Summary of Background Data Little is known about the effect of lateral interbody fusion (LIF) on sagittal plane correction in the setting of degenerative scoliosis. We performed a retrospective study to investigate these changes compared to PSF. Methods Between 1997 and 2011, 33 patients had LIF at 181 levels between T8 and L5 vertebrae for the treatment of degenerative scoliosis (mean; 5±2 levels). Of those, 23 patients had additional anterior lumbar interbody fusion (ALIF) at 37 levels between L4 and S1 vertebrae (mean; 1.6±0.5 levels). A 1:1 matched control of patients who underwent PSF was performed. Patients were matched by age, gender, and diagnosis. Clinical and radiographic data were collected and compared between the matched cohorts. Results Lumbar lordosis was significantly restored in LIF±ALIF compared to PSF cohort (44°±14° versus 36°±15°, p=0.02). The segmental lumbar lordosis over the 102 LIF levels significantly improved from 12°±10° to 21°±13° postoperatively (p<0.0001). However, the change over the 37 ALIF levels was not significant (from 30°±15° to 29°±9°, p=0.8). Sagittal plane alignment was improved in LIF±ALIF compared to PSF cohort and trended toward but did not reach significance (3.8±3.2 cm versus 6.2±5.7 cm, p=0.09). Sacral slope was significantly higher in LIF±ALIF compared to PSF cohort (33°±11° versus 28°±10°, p=0.03). Pelvic tilt was lower in LIF±ALIF compared to PSF cohort and trended toward but did not reach significance (22°±10° versus 26°±10°, p=0.08). Conclusion Lumbar lordosis and sacral slope were mildly but statistically improved in the interbody fusion cohort compared to PSF cohort. Sagittal alignment and pelvic tilt trended toward but did not reach statistical significance. Segmental lumbar lordosis was improved at LIF levels more than at ALIF levels.

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“…ALIF has several advantages over TLIF/PLIF or LLIF. It allows direct access to the disk space with a broad surface area for large grafts that can reduce the nonunion rate, and it affords the ability to create a more lordotic angle [222324]. Moreover, the mini-open midline approach to the L5–S1 or L4–S1 levels minimizes blood loss by reducing the need to handle bony or muscular structures.…”

Section: Introductionmentioning

confidence: 99%

Mini-Open Anterior Lumbar Interbody Fusion Combined with Lateral Lumbar Interbody Fusion in Corrective Surgery for Adult Spinal Deformity

et al. 2016

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Study DesignProspective observational study.PurposeTo introduce the techniques and present the surgical outcomes of mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segments of the spine combined with lateral lumbar interbody fusion (LLIF) for the correction of adult spinal deformityOverview of LiteratureAlthough LLIF is increasingly used to correct adult spinal deformity, the correction of sagittal plane deformity with LLIF alone is reportedly suboptimal.MethodsThirty-two consecutive patients with adult spinal deformity underwent LLIF combined with mini-open ALIF at the L5–S1 or L4–S1 levels followed by 2-stage posterior fixation. ALIF was performed for a mean 1.3 levels and LLIF for a mean 2.7 levels. Then, percutaneous fixation was performed in 11 patients (percutaneous group), open correction with facetectomy with or without laminectomy in 16 (open group), and additional pedicle subtraction osteotomy (PSO) in 5 (PSO group). Spinopelvic parameters were compared preoperatively and postoperatively. Hospitalization data and clinical outcomes were recorded.ResultsNo major medical complications developed, and clinical outcomes improved postoperatively in all groups. The mean postoperative segmental lordosis was greater after ALIF (17.5°±5.5°) than after LLIF (8.1°±5.3°, p <0.001). Four patients (12.5%) had lumbar lordosis with a pelvic incidence of ±9° preoperatively, whereas this outcome was achieved postoperatively in 30 patients (93.8%). The total increase in lumbar lordosis was 14.7° in the percutaneous group, 35.3° in the open group, and 57.0° in the PSO group. The ranges of potential lumbar lordosis increase were estimated as 4°–25°, 23°–42°, and 45°–65°, respectively.ConclusionsMini-open ALIF combined with LLIF followed by posterior fixation may be a feasible technique for achieving optimal sagittal balance and reducing the necessity of more extensive surgery.

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Transforaminal Versus Anterior Lumbar Interbody Fusion in Long Deformity Constructs

Abstract: Spinal deformity surgery used TLIFs rather than ALIFs resulted in shorter operative time with no difference in complication rates. ALIFs provided more segmental lordosis, whereas TLIFs afforded better correction of scoliotic curves.

Cited by 111 publications

References 51 publications

Surgical Treatment Strategies for High-Grade Spondylolisthesis: A Systematic Review

Surgical Treatment Strategies for High-Grade Spondylolisthesis: A Systematic Review

Sagittal Balance and Spinopelvic Parameters After Lateral Lumbar Interbody Fusion for Degenerative Scoliosis

Mini-Open Anterior Lumbar Interbody Fusion Combined with Lateral Lumbar Interbody Fusion in Corrective Surgery for Adult Spinal Deformity

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