Abstract
Impact of lumbar lordosis correction by cephalad versus caudal techniques on the surgical outcomes of adult spinal deformity (ASD) remains unclear.
This study aims to compare the impact of lumbar lordosis correction by cephalad versus caudal techniques on the surgical outcomes of adult spinal deformity (ASD).
Retrospective analysis of prospectively collected data.
Patients were included if they: (1) underwent ASD surgery, (2) had a UIV of L1 or above, (3) a PI_LL >10 at baseline, and (3) had clinical and radiographic follow-up at 2 years postop. Patients with 3-column osteotomies were excluded.
Baseline radiographic parameters, complications, and PROMs.
Patients were included if they: (1) underwent ASD surgery, (2) had a UIV of L1 or above, (3) a PI_LL >10 at baseline, and (4) had clinical and radiographic follow-up at 2 years postoperatively. Patients with 3-column osteotomies were excluded. Patients were stratified into two groups: Caudally restored (L4-S1 between 35 and 45, UIV translation <15) (G1), and those with cephalad lordosis based correction (L1-L4) (G2). Comparative analyses were performed on patient demographics, baseline and 2-year radiographic parameters, complications, and PROMs.
A total of 114 patients were included: 69 (G1), 45 (G2) without sig differences in baseline sagittal alignment, age, sex, BMI, comorbidities, and prior spine surgeries. All of G2 had two or more LLIFs above L4 while G1 did not have any. PROMs were similar, except for worse SRS-total in G2 at 2 years (3.8 vs 3.5, p=0.045). At 2 years, G2 had worse SVA (30.2 vs 56mm), T1PA (17.7 vs 22.5), and more kyphotic T10_L2 (-7.8 vs -13.3°), p≤0.02. G2 had a higher UIV inclination at 6 weeks (-2.5 vs -13.8°, p<.001), 1 yr (-1.9 vs -11.2° p=0.007), and 2 yr (-2.5 vs -9.2°, p=0.03), and were more posteriorly translated at 6 weeks (-9.3 vs -12.1°), and 2 yr (-9.3 vs -12.1°) p=0.01 (Figure 1). G2 had a higher rate of implant-related (5.8 vs 20%) and radiographic complications (1.4 vs 17.8%), abnormal postoperative neurologic exam (29.2 vs 65.5%), and reoperation for PJK (1.4 vs 11.1%) at 2 yr FU, p≤0.02.
Patients who underwent cephalad lordosis-based correction of spinal deformity had potentially less optimal spinal alignment and shape, with greater inclination of the UIV zone and posterior translation of the construct. They also exhibited a higher rate of implant related complications, neurological deficits, and revision for PJK. Caution should be taken when considering performance of more than 2 LLIF's in the treatment of ASD, especially above L4.
This abstract does not discuss or include any applicable devices or drugs.