In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

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

    Final Number:
    208

    Authors:
    Michael Y. Wang MD, FACS; Joseph M. Zavatsky MD; 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:
    Other

    Subject Category:
    Spine

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit- 2017

    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: In the right patient population doing a less disruptive surgery may produce similar patient outcomes.

    Learning Objectives: 1. There were significant improvements in radiographic and clinical outcomes in the IBF (ALIF vs TLIF vs LLIF) vs No IBF Group. 2. LLIF had less posterior segments fused while achieving the greatest coronal Cobb correction.

    References:

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy