Indications and limitations of minimally invasive lateral lumbar interbody fusion without osteotomy for adult spinal deformity

• Published in: European spine journal Vol. 29; no. 6; pp. 1362 - 1370
• Main Authors: Ohba, Tetsuro, Ebata, Shigeto, Ikegami, Shota, Oba, Hiroki, Haro, Hirotaka
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2020; Springer Nature B.V
• Subjects: Medicine; Medicine & Public Health; Neurosurgery; Original Article; Osteotomy; Pelvis; Radiography; Sacrum; Spine (lumbar); Surgery; Surgical Orthopedics; Adult spinal deformity; Minimally invasive lateral lumbar interbody fusion; Global alignment and proportion score; Lordosis distribution index; Mechanical complications; SS in prone position
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-020-06352-4

Purpose The global alignment and proportion (GAP) score was recently developed to consider proportional analysis of spinopelvic alignment and has been indicated for setting surgical goals to decrease the prevalence of mechanical complications. The goal of this study was to clarify the limitations and problems with spinal corrective surgery with minimally invasive lateral lumbar interbody fusion (LLIF) without osteotomy using GAP score, and to establish a preoperative radiographical evaluation to understand the necessity for three-column osteotomy. Methods We included data from 57 consecutive patients treated with spinal corrective surgery with LLIF and without Schwab grade 3–6 osteotomy for ASD. To evaluate flexibility of the pelvis and lumbar spine, we examined full-length lateral radiographs with patients standing and prone. Correlations between pre- and postoperative radiographic parameters and GAP score were determined. Results Most patients achieved a sufficiently ideal lumbar lordosis (87.7%), but ideal sacral slope (SS) was achieved in only 50.8% of patients. Preoperative prone SS showed a significant positive correlation with postoperative SS and a significant negative correlation with GAP score. Patients whose preoperative prone SS was larger than pelvic incidence × 0.59–7.5 tended to achieve proportioned spinopelvic alignment by using LLIF. Conclusions The cause of poor outcome of GAP score for ASD corrective surgery with LLIF without osteotomy is a postoperative small SS. Preoperative prone SS is useful for predicting postoperative SS. When preoperative SS in prone patients is relatively small to ideal as calculated using PI, osteotomy or other correctors should be considered to achieve satisfactory spinopelvic parameters. Level of evidence III. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.