Anterior To Psoas lumbar and lumbosacral combined with posterior reconstruction in Adult Spinal Deformity: A bicentric European study

Brain & Spine · 6 authors, 4 centres

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TL;DR

Preoperative demographics, aetiology, and spinopelvic parameters were comparable between cohorts.

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Preoperative demographics, aetiology, and spinopelvic parameters were comparable between cohorts. At minimum 2-year follow-up, both cohorts demonstrated significant improvements in VAS back/leg pain scores, COMI scores, and all measured spinopelvic radiological parameters compared to baseline. No significant differences were found between OLIF and LLIF for clinical outcomes, radiological parameters, or complication rates. Pseudoarthrosis rate was 5%, lower than published posterior-only technique rates. No iliopsoas or quadriceps weakness was reported in either cohort. Overall complication rate was 72.5% (major 45%, minor 32.5%), though the authors attributed this to prospective collection, inclusion of blood loss exceeding 2000 ml as major, and severe baseline disease.

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cohort

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surgery

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ORIGINAL PAPER

PMC10293315

Anterior To Psoas lumbar and lumbosacral combined with posterior reconstruction in Adult Spinal Deformity: A bicentric European study

Brain & Spine

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ABSTRACT

Abstract Introduction Lateral lumbar fusion via the trans-psoas approach is popular in adult deformity reconstruction. To overcome its limitations (neurological damage to the plexus and lack of applicability to the lumbosacral junction), a modified anterior-to-psoas (ATP) approach has been described and used. Research question To investigate the results of ATP lumbar and lumbosacral fusion, in a cohort of adult patients treated with combined anteroposterior approaches for adult spinal deformity (ASD). Materials and methods ASD patients surgically treated at two tertiary spinal centres were followed up. Forty patients were treated with combined ATP and posterior surgery: 11 with open lumbar lateral interbody-fusions (lumbotomy LLIF) and 29 with lesser invasive oblique lateral interbody-fusions (OLIF). Preoperative demographics, aetiology, clinical characteristics, and spinopelvic parameters were comparable between the two cohorts. Results At a minimum 2-year follow-up, both cohorts showed significant improvements in patient reported outcome measures (PROMs), i.e. Visual Analogue Scale and Core Outcome Measures Index, as well as radiological parameters, with no significant differences based on the type of surgical approach. No significant differences were found in major (P = 0.457) and minor (P = 0.071) complications between the two cohorts. Discusson and conclusion Anterolateral lumbar interbody fusions, whether performed via a direct or oblique approach, proved to be safe and effective adjuvants to posterior surgery in patients with ASD. No significant complication differences were noted between techniques. In addition, the anterior-to-psoas approaches limited the risks of post-operative pseudoarthrosis by providing solid anterior support to lumbar and lumbosacral segments, demonstrating a positive impact on PROMS. Keywords: Adult spinal deformity, Lateral lumbar interbody fusion, Oblique lateral interbody fusion, PROM, Spinal surgery

CITATION EXPORT

Marco Teli, Giuseppe E Umana, Paolo Palmisciano et al.. Anterior To Psoas lumbar and lumbosacral combined with posterior reconstruction in Adult Spinal Deformity: A bicentric European study. Brain & Spine. (2023). https://doi.org/10.1016/j.bas.2023.101718

AUTHORS

6 · 4 CENTRES

Marco Teli, Giuseppe E Umana, Paolo Palmisciano, Maggie K Lee, Simon R Clark, Christian Soda

aDepartment of Neurosurgery, The Walton Centre NHS Trust, Liverpool, UK
bDepartment of Spinal Surgery, Rizzola Academy, Venice, Italy
cDepartment of Neurosurgery, Cannizzaro Hospital, Catania, Italy
dDepartment of Neurosurgery, Hospital Borgo Roma, Verona, Italy