Circumferential Bone Fusion in Adult Spinal Deformity via Combination of Oblique Lateral Interbody Fusion and Grade 2 Posterior Column Osteotomy

Abstract

Study Design Retrospective study Objectives The combination of oblique lateral interbody fusion (OLIF) with grade 2 posterior column osteotomy (PCO) is an effective treatment for adult spinal deformity. However, grade 2 PCO may lead to pseudoarthrosis because it involves complete removal of the bilateral posterior facet joints. The main study objective was to determine the achievement rate of anterior and posterolateral fusion resulting in circumferential fusion in patients who underwent combined OLIF and grade 2 PCO. Methods This retrospective study included consecutive patients who underwent OLIF and grade 2 PCO. The group comprised a long fusion group, with fusion from the thoracic level to the ilium, and a short fusion group, with fusion within the lumbar region. The OLIF with percutaneous pedicle screw insertion group was also used for reference. The Brantigan–Steffee–Fraser classification was used to assess interbody fusion and Lenke classification for assessment of posterolateral fusion. Results Sixty-six patients with 109 lumbar levels were included in the study. We observed 100% anterior fusion in all 3 groups. The fusion rate for posterolateral fusion between the OLIF-grade 2 PCO group was 97%, with very low (3%) non-circumferential fusion (pseudoarthrosis only at the osteotomy site). In most cases, solid posterolateral fusions (Lenke A) occurred within 24 months. Conclusions The combination of OLIF and grade 2 PCO resulted in circumferential fusion for most (97%) of the cases within 24 months. OLIF and grade 2 PCO are considered a good combination treatment to achieve sufficient lumbar lordosis and solid bone fusion.

Finite element analysis for mechanism of occasional anterior longitudinal ligament rupture with posterior correction procedure for adult spinal deformity using LLIF

“…Therefore, in this study, we developed two types of FEA model. In posterior correction procedures for ASD, the cantilever technique is the most important technique for appropriate lumbar lordosis [12,13]. To mimic the cantilever technique in the posterior correction procedure for ASD, we developed a simpli ed FEA model by shortening the distance between the consecutive spinous processes.…”

“…If LLIF secures anterior bone fusion, we can acquire a relatively large amount of lumbar lordosis by performing multilevel grade 2 PCO without the potential risk of pseudoarthrosis for ASD. We previously showed that LLIF and grade 2 PCO are a good combination to acquire su cient lumbar lordosis and solid bone fusion for ASD and other lumbar degenerative diseases [13]. We have been applying this combined OLIF grade 2 PCO procedure in the treatment of these diseases and observed a very high percentage of circumferential bone fusion after surgery [13].…”

“…We previously showed that LLIF and grade 2 PCO are a good combination to acquire su cient lumbar lordosis and solid bone fusion for ASD and other lumbar degenerative diseases [13]. We have been applying this combined OLIF grade 2 PCO procedure in the treatment of these diseases and observed a very high percentage of circumferential bone fusion after surgery [13].…”

“…Meanwhile, grade 2 posterior column osteotomy (PCO) is a very effective and widely used procedure to acquire lumbar lordosis for the surgical treatment of ASD [11][12][13]. Additionally, obtaining appropriate lumbar lordosis for any type of lumbar degenerative disease is essential when fusing any segment to achieve long-term goals.…”

Elucidation of the Mechanism of Occasional Anterior Longitudinal Ligament Rupture with Posterior Correction Procedure for Adult Spinal Deformity Using LLIF–Finite Element Analysis of the Impact of the Lordotic Angle of Intervertebral LLIF Cage

“…Meanwhile, grade 2 posterior column osteotomy (PCO) is a very effective and widely used procedure to acquire lumbar lordosis for the surgical treatment of ASD [ 11 , 12 , 13 ]. Additionally, obtaining appropriate lumbar lordosis for any type of lumbar degenerative disease is essential when fusing any segment to achieve long-term goals.…”