Abstract
Study Design. Retrospective analysis of prospective multicenter adult spinal deformity (ASD) database. Objective. To determine the prevalence and prognosis of postoperative coronal malalignment following LLIF for ASD with Qiu type A coronal alignment. Summary of Background Data. Qiu type A coronal alignment is defined as coronal vertical axis (CVA) <30 mm. There is concern that circumferential minimally invasive surgery (cMIS) with lateral lumbar interbody fusion (LLIF) is associated with postoperative coronal malalignment in ASD with preoperative Qiu type A patients. Materials and Methods. Qui type A patients undergoing cMIS with LLIF for ASD were included, with ASD defined with at least: maximum CC >= 20 degrees, SVA >5 cm, PI-LL >= 10 degrees, or PT >20 degrees. Two-year (2Y) clinical outcomes were compared for type A with 2Y CVA >= 30 mm (MAL) versus <30 mm (ALIGN) and were adjusted for factors reaching P<0.05 on univariate comparisons (age, BMI, and ODI). Results. Forty-three patients met inclusion criteria, of which 12 (27.9%) developed coronal malalignment and 31 (72.1%) remained coronally aligned at 2Y. At baseline, MAL were older (73.0 vs. 69.0, P=0.045), had a lower BMI (26.09 vs. 29.45, P=0.045), and were less disabled (ODI: 42.83 vs. 51.69, P=0.02). Otherwise, the groups were well-matched for baseline characteristics. At 2Y, MAL had a greater 2Y SVA (mean: 54.08 vs. 19.00 mm, P=0.01). Clinically, MAL was associated with inferior 2Y SF-36 PCS (34.78 vs. 37.42, adj P=0.04) and 2Y SRS-22r function/activity domain (3.03 vs. 3.36, adj P=0.04), but otherwise similar in other patient-reported outcome metrics (adj P>0.05 for all). 2Y complications were similar between groups, including for reoperations and major and minor complications (adj P>0.05 for all). Conclusions. In Qui type A patients undergoing cMIS with LLIF for ASD, 27.9% develop coronal malalignment, which was associated with worse SF-36 PCS and SRS-22r function/activity. Despite radiographic malalignment, malalignment was not associated with higher two-year complication rates including reoperations.