[Oblique Lumbar Interbody Fusion Combined with Minimally Invasive Percutaneous Posterior Instrumentation for Adult Spinal Deformity].

ABSTRACT

OBJECTIVE: Minimally invasive surgery(MIS)for adult spinal deformity(ASD)is aimed at minimizing perioperative and postoperative complications. However, MIS techniques have been reported to result in suboptimal sagittal plane correction or pseudoarthrosis when used for severe deformities. The authors present their early experience with circumferential MIS(cMIS), which involves oblique lumbar interbody fusion(OLIF)with percutaneous pedicle screw(PPS)fixation using a rod cantilever technique to enhance lumbar lordosis(LL)for ASD. METHODS: Twenty-one thoracolumbar ASD cases in which surgical correction was performed from the lower thoracic spine corresponded to class IIIa in the modified minimally invasive spinal deformity surgery(MISDEF)algorithm. Patients with a rigid curve and prior fusion were excluded. Surgery was performed in 2 stages. During the first stage, OLIF was performed from L1/2 or Th12/L1 to L4/5. After 4 to 7 days, the patients were re-imaged with standing radiography, and the second-stage surgery was performed with L5/S1 posterior lumbar interbody fusion(PLIF)and percutaneous instrumentation from the lower thoracic spine to the pelvis. Radiological deformity correction at 4 weeks and perioperative complications were evaluated. Scatter plots were created for comparison of preoperative and postoperative sagittal spinopelvic parameters. RESULTS: The patients' mean age was 75 years. The mean operative time was 488 min, and the blood loss was 901 mL. Significant improvement in the spinopelvic parameters were found on the preoperative images of the sagittal vertical axis(SVA)(108mm to 33.5 mm), lumbar lordosis(LL)(18° to 48°), pelvic tilt(PT)(31.8° to 19.2°), and Cobb angle(CA)(21.1° to 11.9°). The change from the preoperative to the postoperative sagittal spinopelvic parameters(SVA, PI-LL, and PT)strongly correlated with preoperative values. CONCLUSION: As cMIS resulted in improvement in spinopelvic parameters and no major complications, this technique could provide a safe and effective strategy to manage ASD even with severe sagittal imbalance.