Seung Won Park1, Myeong Jin Ko2, Young Baeg Kim2, Jean Charles Le Huec3. 1. Department of Neurosurgery, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea. nspsw@cau.ac.kr. 2. Department of Neurosurgery, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea. 3. Head Department of Orthopedic surgery, Polyclinique Bordeaux Nord Aquitaine, 15-35 Rue Claude Boucher, 33300, Bordeaux, France.
Abstract
BACKGROUND: Spinal surgery performed entirely with minimally invasive surgery is referred to as circumferential MIS (cMIS). However, cMIS still has a limited sagittal correction capability for adult spinal deformity (ASD) with a marked sagittal deformity. We investigated the effectiveness of cMIS using oblique lateral interbody fusion (OLIF) and percutaneous posterior spine fixation in correcting marked sagittal deformity. METHODS: This study retrospectively evaluated 23 patients with ASD with marked sagittal deformity who underwent cMIS using OLIF without osteotomy and were followed-up for at least 24 months (whole group). The whole group was divided into the following two groups according to the type of interbody fusion at L5-S1: the OLIF51 group (n = 13) underwent OLIF at L1-L5 and L5-S1 and the TLIF51 group (n = 10) underwent OLIF at L1-L5 and transforaminal lumbar interbody fusion (TLIF) at L5-S1. RESULTS: Sagittal vertebral axis (SVA; 125.7 vs. 29.5 mm, p < 0.001), lumbar lordosis (LL; 18.2° vs. 51.7°, p < 0.001), and pelvic incidence-LL mismatch (PI-LL, 35.5° vs. 5.3°) significantly improved postoperatively in the whole group. The OLIF51 group showed significantly higher postoperative LL than the TLIF51 group (55.5° vs. 46.9°, p < 0.001). OLIF yielded a significantly greater disc angle at L5-S1 than did TLIF (18.4° vs. 6.9°, p < 0.001). Proximal junctional kyphosis occurred significantly earlier in the OLIF51 group than in the TLIF51 group (8.6 vs. 26.3 months, p < 0.001). CONCLUSION: Successful sagittal correction in ASD patients with marked sagittal deformity was achieved with cMIS using OLIF. OLIF at L5-S1 showed a synergistic effect in sagittal deformity correction by cMIS.
BACKGROUND: Spinal surgery performed entirely with minimally invasive surgery is referred to as circumferential MIS (cMIS). However, cMIS still has a limited sagittal correction capability for adult spinal deformity (ASD) with a marked sagittal deformity. We investigated the effectiveness of cMIS using oblique lateral interbody fusion (OLIF) and percutaneous posterior spine fixation in correcting marked sagittal deformity. METHODS: This study retrospectively evaluated 23 patients with ASD with marked sagittal deformity who underwent cMIS using OLIF without osteotomy and were followed-up for at least 24 months (whole group). The whole group was divided into the following two groups according to the type of interbody fusion at L5-S1: the OLIF51 group (n = 13) underwent OLIF at L1-L5 and L5-S1 and the TLIF51 group (n = 10) underwent OLIF at L1-L5 and transforaminal lumbar interbody fusion (TLIF) at L5-S1. RESULTS:Sagittal vertebral axis (SVA; 125.7 vs. 29.5 mm, p < 0.001), lumbar lordosis (LL; 18.2° vs. 51.7°, p < 0.001), and pelvic incidence-LL mismatch (PI-LL, 35.5° vs. 5.3°) significantly improved postoperatively in the whole group. The OLIF51 group showed significantly higher postoperative LL than the TLIF51 group (55.5° vs. 46.9°, p < 0.001). OLIF yielded a significantly greater disc angle at L5-S1 than did TLIF (18.4° vs. 6.9°, p < 0.001). Proximal junctional kyphosis occurred significantly earlier in the OLIF51 group than in the TLIF51 group (8.6 vs. 26.3 months, p < 0.001). CONCLUSION: Successful sagittal correction in ASDpatients with marked sagittal deformity was achieved with cMIS using OLIF. OLIF at L5-S1 showed a synergistic effect in sagittal deformity correction by cMIS.