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  • Impact of Multi-Level Interbody Fusion in the Treatment of Severe Adult Scoliosis (Thoracolumbar Coronal Cobb Angle>50 Degrees)

    Final Number:

    Joseph M Zavatsky MD; Michael Y. Wang MD, FACS; Paul Park MD; Dean Chou MD; Adam S. Kanter MD; Juan S. Uribe MD; Pierce D. Nunley MD; Robert Eastlack MD; Behrooz A. Akbarnia MD; Neel Anand MD; Stacie Nguyen BS MPH; Praveen V. Mummaneni MD; Gregory M. Mundis MD; International Spine Study Group

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: The benefits of surgery in the treatment of severe adult spinal deformity (ASD) have been documented. Specific interbody fusion (IBF) techniques compared to all-posterior technique without IBF have yet to be analyzed.

    Methods: Patients with ASD having thoracolumbar coronal Cobb angles>50, without primary thoracic curves or 3-column osteotomy, and 2-year follow up were included. Patients were split into 2 groups, IBF vs No IBF. IBF included either percutaneous or open pedicle screws. Open: all-posterior without interbody fusion. Differences in demographic, radiographic, and clinical parameters were analyzed. Subgroup analysis of IBF (ALIF vs TLIF vs LLIF) was performed.

    Results: 420 patients met inclusion criteria, of those 165 were identified and 118 had full data for analysis (88 IBF patients; 30 No IBF). IBF were older, had higher BMI, and worse preop ODI (p<0.05). There were differences in pre to post: PT (-3 vs 3, p=0.01), PI-LL (-13.5 vs 5, p<0.001), LL (13.6 vs -3.6, p<0.001), SVA (-36.1 vs 0.6, p=0.002) and ODI (-17.9 vs -7.7, p=0.024) in the IBF vs No IBF. IBF had more staged procedures, blood transfusions, iliac fixation, longer OR time, and LOS (p<0.05). Subgroup analysis revealed LLIF approach had less iliac fixation, EBL, transfusions, and posterior segments fused, while achieving the greatest coronal correction (p<0.05; Table 1).

    Conclusions: IBF resulted in significant improvements in all spinopelvic parameters including SVA. Subgroup analysis of the IBF Group revealed the LLIF technique had significantly less EBL, transfusions, and posterior segments fused, while achieving the greatest coronal correction compared to ALIF and TLIF.

    Patient Care: Understanding which technique best help patients with large coronal deformity will help better their care.

    Learning Objectives: Multicenter retrospective comparison of patients undergoing minimally invasive, hybrid, and open deformity surgery. Patients with thoracolumbar and lumbar coronal Cobb angles > 50 degrees, without primary thoracic curves or 3-column osteotomy correction, with 2-year follow-up were included. Patients were categorized based on interbody fusion (IBF) technique. There were significant improvements in radiographic and clinical outcomes in the IBF (ALIF vs TLIF vs LLIF) vs No IBF Group. LLIF had less posterior segments fused while achieving the greatest coronal Cobb correction.


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