TY - JOUR
T1 - Restoring L4-S1 Lordosis Shape in Severe Sagittal Deformity
T2 - Impact of Correction Techniques on Alignment and Complication Profile
AU - International Spine Study Group
AU - Singh, Manjot
AU - Balmaceno-Criss, Mariah
AU - Daher, Mohammad
AU - Lafage, Renaud
AU - Hamilton, D. Kojo
AU - Smith, Justin S.
AU - Eastlack, Robert K.
AU - Fessler, Richard G.
AU - Gum, Jeffrey L.
AU - Gupta, Munish C.
AU - Hostin, Richard
AU - Kebaish, Khaled M.
AU - Klineberg, Eric O.
AU - Lewis, Stephen J.
AU - Line, Breton G.
AU - Nunley, Pierce D.
AU - Mundis, Gregory M.
AU - Passias, Peter G.
AU - Protopsaltis, Themistocles S.
AU - Buell, Thomas
AU - Ames, Christopher P.
AU - Mullin, Jeffrey P.
AU - Soroceanu, Alex
AU - Scheer, Justin K.
AU - Lenke, Lawrence G.
AU - Bess, Shay
AU - Shaffrey, Christopher I.
AU - Schwab, Frank J.
AU - Lafage, Virginie
AU - Burton, Douglas C.
AU - Diebo, Bassel G.
AU - Daniels, Alan H.
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/9
Y1 - 2024/9
N2 - Background: Severe sagittal plane deformity with loss of L4-S1 lordosis is disabling and can be improved through various surgical techniques. However, data are limited on the differing ability of anterior lumbar interbody fusion (ALIF), pedicle subtraction osteotomy (PSO), and transforaminal lumbar interbody fusion (TLIF) to achieve alignment goals in severely malaligned patients. Methods: Severe adult spinal deformity patients with preoperative PI-LL >20°, L4-S1 lordosis <30°, and full body radiographs and PROMs at baseline and 6-week postoperative visit were included. Patients were grouped into ALIF (1–2 level ALIF at L4-S1), PSO (L4/L5 PSO), and TLIF (1–2 level TLIF at L4-S1). Comparative analyses were performed on demographics, radiographic spinopelvic parameters, complications, and PROMs. Results: Among the 96 included patients, 40 underwent ALIF, 27 underwent PSO, and 29 underwent TLIF. At baseline, cohorts had comparable age, sex, race, Edmonton frailty scores, and radiographic spinopelvic parameters (P > 0.05). However, PSO was performed more often in revision cases (P < 0.001). Following surgery, L4-S1 lordosis correction (P = 0.001) was comparable among ALIF and PSO patients and caudal lordotic apex migration (P = 0.044) was highest among ALIF patients. PSO patients had higher intraoperative estimated blood loss (P < 0.001) and motor deficits (P = 0.049), and in-hospital ICU admission (P = 0.022) and blood products given (P = 0.004), but were otherwise comparable in terms of length of stay, blood transfusion given, and postoperative admission to rehab. Likewise, 90-day postoperative complication profiles and 6-week PROMs were comparable as well. Conclusions: ALIF can restore L4-S1 sagittal alignment as powerfully as PSO, with fewer intraoperative and in-hospital complications. When feasible, ALIF is a suitable alternative to PSO and likely superior to TLIF for correcting L4-S1 lordosis among patients with severe sagittal malalignment.
AB - Background: Severe sagittal plane deformity with loss of L4-S1 lordosis is disabling and can be improved through various surgical techniques. However, data are limited on the differing ability of anterior lumbar interbody fusion (ALIF), pedicle subtraction osteotomy (PSO), and transforaminal lumbar interbody fusion (TLIF) to achieve alignment goals in severely malaligned patients. Methods: Severe adult spinal deformity patients with preoperative PI-LL >20°, L4-S1 lordosis <30°, and full body radiographs and PROMs at baseline and 6-week postoperative visit were included. Patients were grouped into ALIF (1–2 level ALIF at L4-S1), PSO (L4/L5 PSO), and TLIF (1–2 level TLIF at L4-S1). Comparative analyses were performed on demographics, radiographic spinopelvic parameters, complications, and PROMs. Results: Among the 96 included patients, 40 underwent ALIF, 27 underwent PSO, and 29 underwent TLIF. At baseline, cohorts had comparable age, sex, race, Edmonton frailty scores, and radiographic spinopelvic parameters (P > 0.05). However, PSO was performed more often in revision cases (P < 0.001). Following surgery, L4-S1 lordosis correction (P = 0.001) was comparable among ALIF and PSO patients and caudal lordotic apex migration (P = 0.044) was highest among ALIF patients. PSO patients had higher intraoperative estimated blood loss (P < 0.001) and motor deficits (P = 0.049), and in-hospital ICU admission (P = 0.022) and blood products given (P = 0.004), but were otherwise comparable in terms of length of stay, blood transfusion given, and postoperative admission to rehab. Likewise, 90-day postoperative complication profiles and 6-week PROMs were comparable as well. Conclusions: ALIF can restore L4-S1 sagittal alignment as powerfully as PSO, with fewer intraoperative and in-hospital complications. When feasible, ALIF is a suitable alternative to PSO and likely superior to TLIF for correcting L4-S1 lordosis among patients with severe sagittal malalignment.
KW - Adult spinal deformity
KW - Anterior lumbar interbody fusion
KW - Caudal lordosis
KW - Correction
KW - Patient reported outcomes
KW - Pedicle subtraction osteotomy
KW - Sagittal alignment
KW - Spinopelvic parameters
KW - Surgical outcomes
KW - Transforaminal lumbar interbody fusion
UR - http://www.scopus.com/inward/record.url?scp=85197567459&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2024.06.021
DO - 10.1016/j.wneu.2024.06.021
M3 - Article
C2 - 38866236
AN - SCOPUS:85197567459
SN - 1878-8750
VL - 189
SP - e219-e229
JO - World neurosurgery
JF - World neurosurgery
ER -