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

Abstract

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.

The Radiologic and Clinical Outcomes of Oblique Lateral Interbody Fusion for Correction of Adult Degenerative Lumbar Deformity

“…The selection of the most appropriate approach, optimal technique of fusion, and ideal method of deformity correction is of paramount importance while dealing with patients having advanced spinal deformity. Procedures such as pedicle subtraction osteotomies (PSOs) or Smith–Peterson osteotomies (SPOs) were conventionally described for these patients 3678910. These procedures have been associated with longer surgical duration, risk of injury to major vessels, excessive blood loss from segmental or epidural vessels, neurological deficits, loss of correction, and pseudoarthrosis 8911.…”

“…These procedures have been associated with longer surgical duration, risk of injury to major vessels, excessive blood loss from segmental or epidural vessels, neurological deficits, loss of correction, and pseudoarthrosis 8911. Recently, lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF) have been described as an alternative to the conventional posterior only procedures with an aim to minimize the perioperative morbidities and complications 10…”

Anterior lumbar compared to oblique lumbar interbody approaches for multilevel fusions to the sacrum in adults with spinal deformity and degeneration

“…To our knowledge, this is the first report directly comparing multilevel OLIF and ALIF to the sacrum. 8 Both ALIF and LLIF can improve the height and lordosis of the disc space with an acceptable rate of complications. 16 ALIF is generally easier to perform from L4 to S1 because of a single incision, while LLIF has historically been used to treat L2 to L5 because it is harder to access L2-3 via ALIF.…”

“…However, performing the LLIF from L2 to L5 and then performing an ALIF at L5-S1 requires repositioning the patient, repreparation and draping of the patient, a separate skin incision, and mobilization of the abdominal viscera. 7,8 Alternatively, an L5-S1 TLIF can be performed, but this may not be ideal if there is dorsal scar tissue, a clinical need for more lordosis than a TLIF can achieve, or pseudarthrosis requiring an anterior approach.…”

Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls

“…The potential to gain a sagittal alignment may increase with more lordotic cages placed at the lower lumbar spine [ 54 - 58 ]. This action can be achieved by ALIF in the lower lumbar spine [ 57 , 59 ].…”