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Lateral interbody fusion with open posterior surgery found effective for ASD
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Results from this study demonstrated lateral interbody fusion with open posterior surgery was an effective technique in patients with moderately severe thoracolumbar adult spinal deformity.
Researchers reviewed patients with thoracolumbar adult spinal deformity and categorized them by the fusion technique they underwent, either lateral interbody fusion (LIF) with open posterior surgery, which involved facet osteotomies and a rod-cantilever technique to improve lumbar lordosis (n=32) or open posterior surgery alone (n=60). Investigators assessed the patients preoperatively and at 6 weeks, 3 months, 6 months, 12 months and yearly thereafter. Patients completed health-related quality of life questionnaires, which included the VAS for back and leg pain, Oswestry Disability Index (ODI), Scoliosis Research Society-22 and the SF-36 scores.
Results showed there were similar baseline findings and posterior fusion levels for both groups of patients, however preoperative VAS back pain was significantly greater in the combined surgery group.
On average, 3.8 LIFs were performed per patient in the combined group. Although they underwent two surgeries done two days apart, patients who underwent LIF with open posterior surgery had less blood loss and lower durotomy rates, based on study results. In addition, they needed less ICU care and inpatient rehabilitation than patients treated with open posterior surgery alone.
According to researchers, both groups had similar incidences of new leg pain, numbness and weakness. Within 6 months, all the leg symptoms were resolved except in one patient who underwent open posterior surgery. Researchers reported significantly less pseudarthrosis and a greater improvement in VAS back pain and ODI scores among the patients who underwent LIF with open posterior surgery. ‒ by Monica Jaramillo
Disclosures: Strom reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Frank Schwab, MD
This study examines surgical strategies for primary adult deformity of moderate/mild severity. By design the common revision patients or those with marked sagittal plane deformity were excluded. The authors compared two surgical strategies: lateral interbody combined with posterior open surgery vs. open posterior surgery only. In regard to corrections, the combined approach offered better coronal correction (this has limited clinical impact), but open posterior surgery when combined with higher grade osteotomies offered better sagittal plane correction. The data supported claims of fewer failed fusions at 2-year follow up and shorter hospitalization. Remaining questions around cost and alternative strategies, such as greater use of biologics or posterior-based interbody fusion, should be addressed in future studies. However, it appears there is a good role for combined lateral fusions with posterior fusions for select patients.
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