Treatment of Adult Spinal Deformity with Sagittal Imbalance Using Oblique Lumbar Interbody Fusion: Can We Predict How Much Lordosis Correction Is Possible?

Abstract

Study DesignProspective, single-center study.PurposeThe current trend of operative treatment for adult spinal deformity (ASD) is combined anterior-posterior staged surgery. When anterior surgery was first performed, oblique lumbar interbody fusion (OLIF) was employed; this method became increasing popular. This study aimed to determine the lordosis correction that can be achieved using OLIF and assess whether we can preoperatively predict the lordosis correction angle achieved using OLIF.Overview of LiteratureMany previous studies on OLIF have shown improved clinical and radiologic outcomes. With the increase in the popularity of OLIF, several surgeons have started using larger cages to attain greater lordosis correction. Moreover, some studies have reported complications of OLIF because of immoderate cage insertion. To our knowledge, this is the first prospective study that attempted to determine whether it is possible to predict the lordosis correction angle achieved with OLIF preoperatively, using fullextension lateral view (FELV).MethodsForty-six patients with ASD were enrolled. All the operations were performed by a single surgeon in two stages (first, anterior and second, posterior) with a 1-week interval. Radiological evaluation was performed by comparing the Cobb’s angle of the segmental and regional lordosis obtained using preoperative and postoperative simple radiography (including the FELV) and magnetic resonance imaging (MRI).ResultsRegional lordosis (L1–S1) in the whole-spine standing lateral radiograph was −3.03°; however, in the supine lateral MRI, it was 20.92°. The regional lordosis of whole-spine standing lateral and supine lateral (MRI) was significantly different. In the FELV, regional lordosis was 25.72° and that in the postoperative supine lateral (MRI) was 25.02°; these values were not significantly different.ConclusionsAlthough OLIF offers many advantages, it alone plays a limited role in ASD treatment. Lordosis correction using OLIF as well as lordosis determined in the FELV was possible. Hence, our results suggest that FELV can help predict the lordosis correction angle preoperatively and thus aid the selection of the appropriate technique in the second staged operation.

Adult Spinal Deformity: Current Concepts and Decision-Making Strategies for Management

“…They reported a significant difference in the age of patients who underwent MIS and those who underwent open surgeries, with older patients being more suited to MIS owing to poor bone quality and comorbidities. With aging patients who have degenerative scoliosis, MIS can correct sagittal and predominantly coronal deformities, with the LIF showing the greatest change [60][61][62].…”

Lumbar Spinal Fusion Using Lateral Oblique (Pre-psoas) Approach (Review)

“…In most studies on the role of OLIF in the correction of spinal deformities, the authors emphasize the need for posterior osteotomies to achieve an adequate degree of correction. Thus, Kim et al [ 60 ] found that although interbody fusion had some impact on balance correction, the main corrective effect could be achieved only after performing a dorsal approach using osteotomy of the articular processes or even a three-column osteotomy combined with transpedicular fixation. For the correction of rigid deformities, a three-stage treatment with OLIF has also been proposed: at the first stage, posterior release (osteotomy of the articular processes) is performed, at the second stage, multilevel OLIF, and at the third stage, final correction and transpedicular fixation [ 61 ].…”

Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls

“…The surgical oblique view during OLIF is much favorable for the surgeons as compared to LLIF, which only allows a vertical view. Similar to LLIF, OLIF can provide indirect neural decompression and deformity correction [ 29 , 56 , 83 , 84 ]. Meta-analyses have showed that the risks of ipsilateral hip flexor weakness, transient thigh pain, and lumbar plexus injury are lower in OLIF than in LLIF [ 77 , 85 , 86 ].…”