Clinical and Radiologic Analysis of Minimally Invasive Anterior-Posterior Combined Surgery for Adult Spinal Deformity: Comparison of Oblique Lateral Interbody Fusion at L5/S1 (OLIF51) versus Transforaminal Interbody Fusion

Abstract

Background and Objectives: Although adult spinal deformity (ASD) surgery brought about improvement in the quality of life of patients, it is accompanied by high invasiveness and several complications. Specifically, mechanical complications of rod fracture, instrumentation failures, and pseudarthrosis are still unsolved issues. To better improve these problems, oblique lateral interbody fusion at L5/S1 (OLIF51) was introduced in 2015 at my institution. The objective of this study was to compare the clinical and radiologic outcomes of anterior-posterior combined surgery for ASD between the use of OLIF51 and transforaminal interbody fusion (TLIF) at L5/S1. Materials and Methods: A total of 117 ASD patients received anterior-posterior correction surgeries either with the use of OLIF51 (35 patients) or L5/S1 TLIF (82 patients). In both groups, L1-5 OLIF and minimally invasive posterior procedures of hybrid or circumferential MIS were employed. The sagittal and coronal spinal alignment and spino-pelvic parameters were recorded preoperatively and at follow-up. The quality-of-life parameters and visual analogue scale were evaluated, as well as surgical complications at follow-up. Results: The average follow-up period was thirty months (13-84). The number of average fused segments was eight (4-12). The operation time and estimated blood loss were significantly lower in OLIF51 than in TLIF. The PI-LL mismatch, LLL, L5/S1 segmental lordosis, and L5 coronal tilt were significantly better in OLIF51 than TLIF. The complication rate was statistically equivalent between the two groups. Conclusions: The introduction of OLIF51 for adult spine deformity surgery led to a decrease in operation time and estimated blood loss, as well as improvement in sagittal and coronal correction compared to TLIF. The circumferential MIS correction and fusion with OLIF51 serve as an effective surgical modality which can be applied to many cases of adult spinal deformity.

Keywords: OLIF51; adult spinal deformity; minimally invasive surgery; oblique lateral interbody fusion; transforaminal interbody fusion.

Figure 1

Circumferential MIS procedure with multiple OLIFs and all percutaneous posterior corrections. (A) The OLIF51 procedure utilizes the specially designed triple-arm retractor. (B) All percutaneous posterior correction procedures.

Figure 2

OLIF51 with use of the Sovereign hyperlordotic cage fixed with integrated screws and demineralized bone matrix soaked with aspirated bone marrow.

Figure 3

Operation time and estimated blood loss (EBL) for the two groups. The asterisk depicts statistical significance at the p < 0.05 level between two groups.

Figure 4

JOABPEQ effectiveness rate (%) for the two groups. The asterisk depicts statistical significance at the p < 0.05 level between two groups.

Figure 5

Seventy-eight-year-old female, degenerative lumbar scoliosis. The successful cMIS with OLIF51 was performed with a total blood loss of 294 mL.

Figure 6

Sixty-eight-year-old female, adult scoliosis. The successful cMIS with OLIF51 was performed with a total operation time of 374 min and estimated blood loss of 594 mL. The preoperative Cobb angle of 63 degree was corrected to 7 degrees at follow-up. The preoperative PI-LL of 54 degrees was corrected to 2 degrees at follow-up.