Norton Leatherman Spine Center, Louisville, KY, USA.
Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY, 40202, USA.
Spine Deform. 2021 Sep;9(5):1443-1447. doi: 10.1007/s43390-021-00328-0. Epub 2021 Mar 19.
Retrospective chart review.
To determine if the addition of an anterior lumbar interbody fusion (ALIF) improves the fractional curve in adult spinal deformity correction when compared to posterior surgery alone. ALIF is commonly advocated to improve lordosis and fusion in adult deformity surgery. Improved fractional curve correction may help level the pelvis and minimize proximal malalignment.
Patients undergoing thoracolumbar fusion to the pelvis with S2AI screws for deformity were identified and stratified into patients who had an ALIF as part of their deformity correction procedure (ALIF + PSF), and those who had a posterior approach alone. The posterior approach (PSF) includes patients who had a posterolateral fusion with or without a transforaminal lumbar interbody fusion (TLIF). Radiographic parameters measured included pre-op and post-op fractional coronal curve Cobb angle, lumbar lordosis, pelvic tilt, pelvic incidence and sacral slope, major Cobb angle, coronal and sagittal SVA.
There were 31 cases in the ALIF + PSF group and 28 in the PSF group. Baseline demographic characteristics of the two groups were similar. Mean pre-op fractional coronal Cobb (18.3° vs 13.4°, p = 0.027) was larger in the ALIF + PSF group, whereas lumbar lordosis (31.0° vs 33.6°, p = 0.487) and pelvic parameters were similar between the two groups. Post-op lumbar lordosis was similar (48.2° vs 43.0°, p = 0.092). Greater fractional coronal curve correction was achieved in the ALIF + PSF group (67%) compared to the PSF group (36%) with a smaller post-op fractional coronal curve in the ALIF + PSF group (6.1°) compared to the PSF group (8.6°, p = 0.053).
There is a greater correction of the fractional curve in the ALIF + PSF group compared with the PSF group. While this may not be the primary indication for ALIF, it is a benefit which may facilitate overall deformity correction and leveling of the pelvis.
回顾性图表回顾。
确定与单纯后路手术相比，前路腰椎椎间融合术（ALIF）是否能改善成人脊柱畸形矫正的部分曲线。ALIF 通常被提倡用于改善成人畸形手术中的脊柱前凸和融合。改善部分曲线矫正可能有助于使骨盆水平并最小化近端对线不良。
确定并将接受胸腰椎至骨盆 S2AI 螺钉融合治疗的脊柱畸形患者分为接受 ALIF 作为其畸形矫正手术一部分的患者（ALIF+PSF）和仅接受后路手术的患者。后路手术（PSF）包括接受后路侧融合伴或不伴经椎间孔腰椎间融合术（TLIF）的患者。测量的影像学参数包括术前和术后部分冠状曲线 Cobb 角、腰椎前凸、骨盆倾斜、骨盆入射角和骶骨倾斜角、主要 Cobb 角、冠状和矢状面 SVA。
ALIF+PSF 组有 31 例，PSF 组有 28 例。两组的基线人口统计学特征相似。ALIF+PSF 组的平均术前部分冠状 Cobb（18.3° vs 13.4°，p=0.027）较大，而腰椎前凸（31.0° vs 33.6°，p=0.487）和骨盆参数在两组之间相似。术后腰椎前凸相似（48.2° vs 43.0°，p=0.092）。ALIF+PSF 组的部分冠状曲线矫正程度更大（67%），而 PSF 组的部分冠状曲线矫正程度较小（36%），ALIF+PSF 组的术后部分冠状曲线较小（6.1°），而 PSF 组的术后部分冠状曲线较大（8.6°，p=0.053）。
与 PSF 组相比，ALIF+PSF 组的部分曲线矫正程度更大。虽然这可能不是 ALIF 的主要适应证，但它是一种可以促进整体畸形矫正和骨盆水平的益处。
