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Indications and limitations of minimally invasive lateral lumbar interbody fusion without osteotomy for adult spinal deformity

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Abstract

Purpose

The global alignment and proportion (GAP) score was recently developed to consider proportional analysis of spinopelvic alignment and has been indicated for setting surgical goals to decrease the prevalence of mechanical complications. The goal of this study was to clarify the limitations and problems with spinal corrective surgery with minimally invasive lateral lumbar interbody fusion (LLIF) without osteotomy using GAP score, and to establish a preoperative radiographical evaluation to understand the necessity for three-column osteotomy.

Methods

We included data from 57 consecutive patients treated with spinal corrective surgery with LLIF and without Schwab grade 3–6 osteotomy for ASD. To evaluate flexibility of the pelvis and lumbar spine, we examined full-length lateral radiographs with patients standing and prone. Correlations between pre- and postoperative radiographic parameters and GAP score were determined.

Results

Most patients achieved a sufficiently ideal lumbar lordosis (87.7%), but ideal sacral slope (SS) was achieved in only 50.8% of patients. Preoperative prone SS showed a significant positive correlation with postoperative SS and a significant negative correlation with GAP score. Patients whose preoperative prone SS was larger than pelvic incidence × 0.59–7.5 tended to achieve proportioned spinopelvic alignment by using LLIF.

Conclusions

The cause of poor outcome of GAP score for ASD corrective surgery with LLIF without osteotomy is a postoperative small SS. Preoperative prone SS is useful for predicting postoperative SS. When preoperative SS in prone patients is relatively small to ideal as calculated using PI, osteotomy or other correctors should be considered to achieve satisfactory spinopelvic parameters.

Level of evidence

III.

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Acknowledgements

We did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors for this research. The manuscript submitted does not contain information about medical device(s)/drug(s).

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No funds were received in support of this work. No relevant financial activities outside the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Tetsuro Ohba, Shigeto Ebata, Hiroki Oba & Hirotaka Haro

  2. Department of Orthopaedic Surgery, School of Medicine, Shinshu University, Matsumoto, Japan

    Shota Ikegami & Hiroki Oba

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  1. Tetsuro Ohba
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Correspondence to Tetsuro Ohba.

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The study was approved by our institutional review board (Approval No. 1183).

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Ohba, T., Ebata, S., Ikegami, S. et al. Indications and limitations of minimally invasive lateral lumbar interbody fusion without osteotomy for adult spinal deformity. Eur Spine J 29, 1362–1370 (2020). https://doi.org/10.1007/s00586-020-06352-4

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