Abstract：
BACKGROUND: Severe sagittal plane deformity with loss of L4-S1 lordosis is disabling and can be improved through various surgical techniques. However, data is limited on the differing ability of anterior lumbar interbody fusion (ALIF), pedicle subtraction osteotomy (PSO), and transforaminal lumbar interbody fusion (TLIF) to achieve alignment goals in severely malaligned patients.
OBJECTIVE: To examine surgical techniques aimed at restoring L4-S1 lordosis in severe adult spinal deformity (ASD).
METHODS: Retrospective review of prospectively collected data.
METHODS: A total of 96 patients who underwent ALIF, PSO, and TLIF were included in this study.
METHODS: The following data were observed for all cases: patient demographics, spinopelvic parameters, complications, and PROMs.
METHODS: Severe ASD patients with preoperative PI-LL >20°, L4-S1 lordosis <30°, and full body radiographs and patient-reported outcome measures (PROMs) at baseline and six-week postoperative visit were included. Patients were grouped into ALIF (1-2 level ALIF at L4-S1), PSO (L4/L5 PSO), and TLIF (1-2 level TLIF at L4-S1). Comparative analyses were performed on demographics, radiographic spinopelvic parameters, complications, and PROMs.
RESULTS: Among the 96 included patients, 40 underwent ALIF, 27 underwent PSO, and 29 underwent TLIF. At baseline, cohorts had comparable age, sex, race, Edmonton frailty scores and radiographic spinopelvic parameters (p>0.05). However, PSO was performed more often in revision cases (p<0.001). Following surgery, L4-S1 lordosis correction (p=0.001) was comparable among ALIF and PSO patients and caudal lordotic apex migration (p=0.044) was highest among ALIF patients. PSO patients had higher intraoperative estimated blood loss (p<0.001) and motor deficits (p=0.049), and in-hospital ICU admission (p=0.022) and blood products given (p=0.004) but were otherwise comparable in terms of length of stay, blood transfusion given, and postoperative admission to rehab. Likewise, 90-day postoperative complication profiles and six-week PROMs were comparable as well.
CONCLUSIONS: ALIF can restore L4-S1 sagittal alignment as powerfully as PSO, with fewer intra-operative and in-hospital complications. When feasible, ALIF is a suitable alternative to PSO and likely superior to TLIF for correcting L4-S1 lordosis among patients with severe sagittal malalignment.
OBJECTIVE: To examine surgical techniques aimed at restoring L4-S1 lordosis in severe adult spinal deformity (ASD).
METHODS: Retrospective review of prospectively collected data.
METHODS: A total of 96 patients who underwent ALIF, PSO, and TLIF were included in this study.
METHODS: The following data were observed for all cases: patient demographics, spinopelvic parameters, complications, and PROMs.
METHODS: Severe ASD patients with preoperative PI-LL >20°, L4-S1 lordosis <30°, and full body radiographs and patient-reported outcome measures (PROMs) at baseline and six-week postoperative visit were included. Patients were grouped into ALIF (1-2 level ALIF at L4-S1), PSO (L4/L5 PSO), and TLIF (1-2 level TLIF at L4-S1). Comparative analyses were performed on demographics, radiographic spinopelvic parameters, complications, and PROMs.
RESULTS: Among the 96 included patients, 40 underwent ALIF, 27 underwent PSO, and 29 underwent TLIF. At baseline, cohorts had comparable age, sex, race, Edmonton frailty scores and radiographic spinopelvic parameters (p>0.05). However, PSO was performed more often in revision cases (p<0.001). Following surgery, L4-S1 lordosis correction (p=0.001) was comparable among ALIF and PSO patients and caudal lordotic apex migration (p=0.044) was highest among ALIF patients. PSO patients had higher intraoperative estimated blood loss (p<0.001) and motor deficits (p=0.049), and in-hospital ICU admission (p=0.022) and blood products given (p=0.004) but were otherwise comparable in terms of length of stay, blood transfusion given, and postoperative admission to rehab. Likewise, 90-day postoperative complication profiles and six-week PROMs were comparable as well.
CONCLUSIONS: ALIF can restore L4-S1 sagittal alignment as powerfully as PSO, with fewer intra-operative and in-hospital complications. When feasible, ALIF is a suitable alternative to PSO and likely superior to TLIF for correcting L4-S1 lordosis among patients with severe sagittal malalignment.
摘要：
背景：严重的矢状面畸形伴L4-S1脊柱前凸丧失是致残的，可以通过各种手术技术得到改善。然而,关于腰椎前路椎间融合术（ALIF）的不同能力的数据有限，椎弓根减影截骨术（PSO），和经椎间孔腰椎椎间融合术（TLIF），以实现严重畸形患者的对准目标。
目的：研究旨在恢复严重成人脊柱畸形（ASD）L4-S1脊柱前凸的手术技术。
方法：回顾性回顾前瞻性收集的数据。
方法：共有96例接受ALIF的患者，PSO,和TLIF纳入本研究。
方法：所有病例均观察到以下数据：患者人口统计学，脊椎骨盆参数，并发症,
方法：术前PI-LL>20°的严重ASD患者，L4-S1脊柱前凸<30°,纳入了基线和术后6周访视时的全身X光片和患者报告的结局指标(PROMs).患者分为ALIF（L4-S1为1-2水平ALIF），PSO(L4/L5PSO),和TLIF（1-2级TLIF在L4-S1）。对人口统计学进行了比较分析，放射学脊柱骨盆参数，并发症,
结果：在纳入的96名患者中，40接受了ALIF，27人接受了PSO，29人接受了TLIF。在基线,同伙的年龄相当，性别,种族,埃德蒙顿虚弱评分和影像学脊柱骨盆参数(p>0.05)。然而,PSO在修订病例中更常见(p<0.001)。手术后,L4-S1脊柱前凸校正（p=0.001）在ALIF和PSO患者中具有可比性，而在ALIF患者中，尾前凸顶点迁移（p=0.044）最高。PSO患者术中估计失血量（p<0.001）和运动障碍（p=0.049）较高，入院ICU（p=0.022）和给予血液制品（p=0.004），但在住院时间方面具有可比性，输血，术后入院康复。同样，术后90天的并发症和6周的PROM也具有可比性。
结论：ALIF可以像PSO一样强大地恢复L4-S1矢状对齐，术中和院内并发症较少。在可行的情况下,ALIF是PSO的合适替代方案，并且可能优于TLIF，可用于纠正严重矢状面错位患者的L4-S1脊柱前凸。
目的：研究旨在恢复严重成人脊柱畸形（ASD）L4-S1脊柱前凸的手术技术。
方法：回顾性回顾前瞻性收集的数据。
方法：共有96例接受ALIF的患者，PSO,和TLIF纳入本研究。
方法：所有病例均观察到以下数据：患者人口统计学，脊椎骨盆参数，并发症,
方法：术前PI-LL>20°的严重ASD患者，L4-S1脊柱前凸<30°,纳入了基线和术后6周访视时的全身X光片和患者报告的结局指标(PROMs).患者分为ALIF（L4-S1为1-2水平ALIF），PSO(L4/L5PSO),和TLIF（1-2级TLIF在L4-S1）。对人口统计学进行了比较分析，放射学脊柱骨盆参数，并发症,
结果：在纳入的96名患者中，40接受了ALIF，27人接受了PSO，29人接受了TLIF。在基线,同伙的年龄相当，性别,种族,埃德蒙顿虚弱评分和影像学脊柱骨盆参数(p>0.05)。然而,PSO在修订病例中更常见(p<0.001)。手术后,L4-S1脊柱前凸校正（p=0.001）在ALIF和PSO患者中具有可比性，而在ALIF患者中，尾前凸顶点迁移（p=0.044）最高。PSO患者术中估计失血量（p<0.001）和运动障碍（p=0.049）较高，入院ICU（p=0.022）和给予血液制品（p=0.004），但在住院时间方面具有可比性，输血，术后入院康复。同样，术后90天的并发症和6周的PROM也具有可比性。
结论：ALIF可以像PSO一样强大地恢复L4-S1矢状对齐，术中和院内并发症较少。在可行的情况下,ALIF是PSO的合适替代方案，并且可能优于TLIF，可用于纠正严重矢状面错位患者的L4-S1脊柱前凸。
