Multicenter assessment of outcomes and complications associated with transforaminal versus anterior lumbar interbody fusion for fractional curve correction

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  • 1 Department of Orthopaedic & Neurological Surgery, Duke University Medical Center, Durham, North Carolina;
  • | 2 Denver International Spine Center, Presbyterian/St. Luke’s Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado;
  • | 3 Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York;
  • | 4 Department of Orthopaedic Surgery, University of California, Davis, California;
  • | 5 Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York;
  • | 6 Scripps Clinic and San Diego Center for Spinal Disorders, La Jolla, California;
  • | 7 Departments of Orthopaedic Surgery and
  • | 8 Neurological Surgery, University of California, San Francisco, California;
  • | 9 Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri;
  • | 10 Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island;
  • | 11 Department of Orthopaedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky;
  • | 12 Department of Orthopaedic Surgery, University of Calgary, Alberta, Canada;
  • | 13 Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;
  • | 14 Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas;
  • | 15 Department of Orthopaedic Surgery, Southwest Scoliosis Institute, Baylor Scott and White Medical Center, Plano, Texas;
  • | 16 Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland;
  • | 17 Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington; and
  • | 18 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
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OBJECTIVE

Few studies have compared fractional curve correction after long fusion between transforaminal lumbar interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) for adult symptomatic thoracolumbar/lumbar scoliosis (ASLS). The objective of this study was to compare fractional correction, health-related quality of life (HRQL), and complications associated with L4–S1 TLIF versus those of ALIF as an operative treatment of ASLS.

METHODS

The authors retrospectively analyzed a prospective multicenter adult spinal deformity database. Inclusion required a fractional curve ≥ 10°, a thoracolumbar/lumbar curve ≥ 30°, index TLIF or ALIF performed at L4–5 and/or L5–S1, and a minimum 2-year follow-up. TLIF and ALIF patients were propensity matched according to the number and type of interbody fusion at L4–S1.

RESULTS

Of 135 potentially eligible consecutive patients, 106 (78.5%) achieved the minimum 2-year follow-up (mean ± SD age 60.6 ± 9.3 years, 85% women, 44.3% underwent TLIF, and 55.7% underwent ALIF). Index operations had mean ± SD 12.2 ± 3.6 posterior levels, 86.6% of patients underwent iliac fixation, 67.0% underwent TLIF/ALIF at L4–5, and 84.0% underwent TLIF/ALIF at L5–S1. Compared with TLIF patients, ALIF patients had greater cage height (10.9 ± 2.1 mm for TLIF patients vs 14.5 ± 3.0 mm for ALIF patients, p = 0.001) and lordosis (6.3° ± 1.6° for TLIF patients vs 17.0° ± 9.9° for ALIF patients, p = 0.001) and longer operative duration (6.7 ± 1.5 hours for TLIF patients vs 8.9 ± 2.5 hours for ALIF patients, p < 0.001). In all patients, final alignment improved significantly in terms of the fractional curve (20.2° ± 7.0° to 6.9° ± 5.2°), maximum coronal Cobb angle (55.0° ± 14.8° to 23.9° ± 14.3°), C7 sagittal vertical axis (5.1 ± 6.2 cm to 2.3 ± 5.4 cm), pelvic tilt (24.6° ± 8.1° to 22.7° ± 9.5°), and lumbar lordosis (32.3° ± 18.8° to 51.4° ± 14.1°) (all p < 0.05). Matched analysis demonstrated comparable fractional correction (−13.6° ± 6.7° for TLIF patients vs −13.6° ± 8.1° for ALIF patients, p = 0.982). In all patients, final HRQL improved significantly in terms of Oswestry Disability Index (ODI) score (42.4 ± 16.3 to 24.2 ± 19.9), physical component summary (PCS) score of the 36-item Short-Form Health Survey (32.6 ± 9.3 to 41.3 ± 11.7), and Scoliosis Research Society–22r score (2.9 ± 0.6 to 3.7 ± 0.7) (all p < 0.05). Matched analysis demonstrated worse ODI (30.9 ± 21.1 for TLIF patients vs 17.9 ± 17.1 for ALIF patients, p = 0.017) and PCS (38.3 ± 12.0 for TLIF patients vs 45.3 ± 10.1 for ALIF patients, p = 0.020) scores for TLIF patients at the last follow-up (despite no differences in these parameters at baseline). The rates of total complications were similar (76.6% for TLIF patients vs 71.2% for ALIF patients, p = 0.530), but significantly more TLIF patients had rod fracture (28.6% of TLIF patients vs 7.1% of ALIF patients, p = 0.036). Multiple regression analysis demonstrated that a 1-mm increase in L4–5 TLIF cage height led to a 2.2° reduction in L4 coronal tilt (p = 0.011), and a 1° increase in L5–S1 ALIF cage lordosis led to a 0.4° increase in L5–S1 segmental lordosis (p = 0.045).

CONCLUSIONS

Operative treatment of ASLS with L4–S1 TLIF versus ALIF demonstrated comparable mean fractional curve correction (66.7% vs 64.8%), despite use of significantly larger, more lordotic ALIF cages. TLIF cage height had a significant impact on leveling L4 coronal tilt, whereas ALIF cage lordosis had a significant impact on restoration of lumbosacral lordosis. The advantages of TLIF may include reduced operative duration and hospitalization; however, associated HRQL was inferior and more rod fractures were detected in the TLIF patients included in this study.

ABBREVIATIONS

ALIF = anterior lumbar interbody fusion; ASD = adult spinal deformity; ASLS = adult symptomatic TL/L scoliosis; GCA = global coronal alignment; GCM = global coronal malalignment; HRQL = health-related quality of life; LL = lumbar lordosis; MCID = minimal clinically important difference; MCS = mental component summary; NRS = numerical rating scale; ODI = Oswestry Disability Index; PCS = physical component summary; PI = pelvic incidence; PI-LL = mismatch between PI and LL; SF-36 = 36-item Short-Form Health Survey; SRS = Scoliosis Research Society; SVA = sagittal vertical axis; TLIF = transforaminal lumbar interbody fusion; TL/L = thoracolumbar/lumbar.

Supplementary Materials

    • Supplemental Data (PDF 871 KB)
Images and illustration from Akinduro et al. (pp 834–843). Copyright Tito Vivas-Buitrago. Published with permission.

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  • 1

    Ferrero E, Khalifé M, Marie-Hardy L, et al. Do curve characteristics influence stenosis location and occurrence of radicular pain in adult degenerative scoliosis?. Spine Deform. 2019;7(3):472480.

    • Search Google Scholar
    • Export Citation
  • 2

    Jackson RP, Simmons EH, Stripinis D. Incidence and severity of back pain in adult idiopathic scoliosis. Spine (Phila Pa 1976). 1983;8(7):749756.

    • Search Google Scholar
    • Export Citation
  • 3

    Jackson RP, Simmons EH, Stripinis D. Coronal and sagittal plane spinal deformities correlating with back pain and pulmonary function in adult idiopathic scoliosis. Spine (Phila Pa 1976). 1989;14(12):13911397.

    • Search Google Scholar
    • Export Citation
  • 4

    Campbell PG, Nunley PD. The challenge of the lumbosacral fractional curve in the setting of adult degenerative scoliosis. Neurosurg Clin N Am. 2018;29(3):467474.

    • Search Google Scholar
    • Export Citation
  • 5

    Chou D, Mummaneni P, Anand N, et al. Treatment of the fractional curve of adult scoliosis with circumferential minimally invasive surgery versus traditional, open surgery: an analysis of surgical outcomes. Global Spine J. 2018;8(8):827833.

    • Search Google Scholar
    • Export Citation
  • 6

    Tan ZY, Donnelly DF, LaMotte RH. Effects of a chronic compression of the dorsal root ganglion on voltage-gated Na+ and K+ currents in cutaneous afferent neurons. J Neurophysiol. 2006;95(2):11151123.

    • Search Google Scholar
    • Export Citation
  • 7

    Wang T, Hurwitz O, Shimada SG, et al. Chronic compression of the dorsal root ganglion enhances mechanically evoked pain behavior and the activity of cutaneous nociceptors in mice. PLoS One. 2015;10(9):e0137512.

    • Search Google Scholar
    • Export Citation
  • 8

    Amara D, Mummaneni PV, Ames CP, et al. Treatment of only the fractional curve for radiculopathy in adult scoliosis: comparison to lower thoracic and upper thoracic fusions. J Neurosurg Spine. 2019;30(4):506514.

    • Search Google Scholar
    • Export Citation
  • 9

    Smith JS, Fu KM, Urban P, Shaffrey CI. Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management. J Neurosurg Spine. 2008;9(4):326331.

    • Search Google Scholar
    • Export Citation
  • 10

    Smith JS, Shaffrey CI, Berven S, et al. Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976). 2009;34(16):16931698.

    • Search Google Scholar
    • Export Citation
  • 11

    Kelly MP, Lurie JD, Yanik EL, et al. Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis. J Bone Joint Surg Am. 2019;101(4):338352.

    • Search Google Scholar
    • Export Citation
  • 12

    Smith JS, Shaffrey CI, Berven S, et al. Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery. 2009;65(1):8694.

    • Search Google Scholar
    • Export Citation
  • 13

    Lewis SJ, Keshen SG, Kato S, et al. Risk factors for postoperative coronal balance in adult spinal deformity surgery. Global Spine J. 2018;8(7):690697.

    • Search Google Scholar
    • Export Citation
  • 14

    Miller EK, Neuman BJ, Jain A, et al. An assessment of frailty as a tool for risk stratification in adult spinal deformity surgery. Neurosurg Focus. 2017;43(6):E3.

    • Search Google Scholar
    • Export Citation
  • 15

    Champain S, Benchikh K, Nogier A, et al. Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies. Eur Spine J. 2006;15(6):982991.

    • Search Google Scholar
    • Export Citation
  • 16

    Rillardon L, Levassor N, Guigui P, et al. Validation of a tool to measure pelvic and spinal parameters of sagittal balance. Article in French. Rev Chir Orthop Repar Appar Mot. 2003;89(3):218227.

    • Search Google Scholar
    • Export Citation
  • 17

    O’Brien MF, Kuklo TR, Blanke K, and Lenke L, eds.Spinal Deformity Study Group Radiographic Measurement Manual. Medtronic Sofamor Danek; 2005.

    • Search Google Scholar
    • Export Citation
  • 18

    Plais N, Bao H, Lafage R, et al. The clinical impact of global coronal malalignment is underestimated in adult patients with thoracolumbar scoliosis. Spine Deform. 2020;8(1):105113.

    • Search Google Scholar
    • Export Citation
  • 19

    Daniels AH, DePasse JM, Durand W, et al. Rod fracture after apparently solid radiographic fusion in adult spinal deformity patients. World Neurosurg. 2018;117:e530e537.

    • Search Google Scholar
    • Export Citation
  • 20

    Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271273.

    • Search Google Scholar
    • Export Citation
  • 21

    Ware JE Jr. SF-36 health survey update. Spine (Phila Pa 1976). 2000;25(24):31303139.

  • 22

    Bridwell KH, Berven S, Glassman S, et al. Is the SRS-22 instrument responsive to change in adult scoliosis patients having primary spinal deformity surgery?. Spine (Phila Pa 1976). 2007;32(20):22202225.

    • Search Google Scholar
    • Export Citation
  • 23

    Asher MA, Lai SM, Glattes RC, et al. Refinement of the SRS-22 Health-Related Quality of Life questionnaire Function domain. Spine (Phila Pa 1976). 2006;31(5):593597.

    • Search Google Scholar
    • Export Citation
  • 24

    Copay AG, Glassman SD, Subach BR, et al. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8(6):968974.

    • Search Google Scholar
    • Export Citation
  • 25

    Liu S, Schwab F, Smith JS, et al. Likelihood of reaching minimal clinically important difference in adult spinal deformity: a comparison of operative and nonoperative treatment. Ochsner J. 2014;14(1):6777.

    • Search Google Scholar
    • Export Citation
  • 26

    Glassman SD, Copay AG, Berven SH, et al. Defining substantial clinical benefit following lumbar spine arthrodesis. J Bone Joint Surg Am. 2008;90(9):18391847.

    • Search Google Scholar
    • Export Citation
  • 27

    Smith JS, Shaffrey CI, Klineberg E, et al. Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up. J Neurosurg Spine. 2017;27(4):444457.

    • Search Google Scholar
    • Export Citation
  • 28

    Smith JS, Klineberg E, Lafage V, et al. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine. 2016;25(1):114.

    • Search Google Scholar
    • Export Citation
  • 29

    Nguyen JH, Buell TJ, Wang TR, et al. Low rates of complications after spinopelvic fixation with iliac screws in 260 adult patients with a minimum 2-year follow-up. J Neurosurg Spine. 2019;30(5):635643.

    • Search Google Scholar
    • Export Citation
  • 30

    Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus. 2010;28(3):E1.

  • 31

    Kebaish KM. Sacropelvic fixation: techniques and complications. Spine (Phila Pa 1976). 2010;35(25):22452251.

  • 32

    Crandall DG, Revella J. Transforaminal lumbar interbody fusion versus anterior lumbar interbody fusion as an adjunct to posterior instrumented correction of degenerative lumbar scoliosis: three year clinical and radiographic outcomes. Spine (Phila Pa 1976). 2009;34(20):21262133.

    • Search Google Scholar
    • Export Citation
  • 33

    Buell TJ, Chen CJ, Nguyen JH, et al. Surgical correction of severe adult lumbar scoliosis (major curves ≥ 75°): retrospective analysis with minimum 2-year follow-up. J Neurosurg Spine. 2019;31(4):548561.

    • Search Google Scholar
    • Export Citation
  • 34

    Jagannathan J, Sansur CA, Oskouian RJ Jr, et al. Radiographic restoration of lumbar alignment after transforaminal lumbar interbody fusion. Neurosurgery. 2009;64(5):955964.

    • Search Google Scholar
    • Export Citation
  • 35

    Hsieh PC, Koski TR, O’Shaughnessy BA, et al. Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine. 2007;7(4):379386.

    • Search Google Scholar
    • Export Citation
  • 36

    Phan K, Thayaparan GK, Mobbs RJ. Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion—systematic review and meta-analysis. Br J Neurosurg. 2015;29(5):705711.

    • Search Google Scholar
    • Export Citation
  • 37

    Jiang SD, Chen JW, Jiang LS. Which procedure is better for lumbar interbody fusion: anterior lumbar interbody fusion or transforaminal lumbar interbody fusion?. Arch Orthop Trauma Surg. 2012;132(9):12591266.

    • Search Google Scholar
    • Export Citation
  • 38

    Ajiboye RM, Alas H, Mosich GM, et al. Radiographic and clinical outcomes of anterior and transforaminal lumbar interbody fusions: a systematic review and meta-analysis of comparative studies. Clin Spine Surg. 2018;31(4):E230E238.

    • Search Google Scholar
    • Export Citation
  • 39

    Salehi SA, Tawk R, Ganju A, et al. Transforaminal lumbar interbody fusion: surgical technique and results in 24 patients. Neurosurgery. 2004;54(2):368374.

    • Search Google Scholar
    • Export Citation
  • 40

    Smith JA, Deviren V, Berven S, Bradford DS. Does instrumented anterior scoliosis surgery lead to kyphosis, pseudarthrosis, or inadequate correction in adults? Spine. Spine (Phila Pa 1976). 2002;27(5):529534.

    • Search Google Scholar
    • Export Citation
  • 41

    Dorward IG, Lenke LG, Bridwell KH, et al. Transforaminal versus anterior lumbar interbody fusion in long deformity constructs: a matched cohort analysis. Spine (Phila Pa 1976). 2013;38(12):E755E762.

    • Search Google Scholar
    • Export Citation
  • 42

    Smith JS, Shaffrey CI, Lafage V, et al. Comparison of best versus worst clinical outcomes for adult spinal deformity surgery: a retrospective review of a prospectively collected, multicenter database with 2-year follow-up. J Neurosurg Spine. 2015;23(3):349359.

    • Search Google Scholar
    • Export Citation
  • 43

    Smith JS, Shaffrey CI, Kelly MP, et al. Effect of serious adverse events on health-related quality of life measures following surgery for adult symptomatic lumbar scoliosis. Spine (Phila Pa 1976). 2019;44(17):12111219.

    • Search Google Scholar
    • Export Citation
  • 44

    Buell TJ, Nguyen JH, Mazur MD, et al. Radiographic outcome and complications after single-level lumbar extended pedicle subtraction osteotomy for fixed sagittal malalignment: a retrospective analysis of 55 adult spinal deformity patients with a minimum 2-year follow-up. J Neurosurg Spine. 2018;30(2):242252.

    • Search Google Scholar
    • Export Citation
  • 45

    Gupta S, Eksi MS, Ames CP, et al. A novel 4-rod technique offers potential to reduce rod breakage and pseudarthrosis in pedicle subtraction osteotomies for adult spinal deformity correction. Oper Neurosurg (Hagerstown). 2018;14(4):449456.

    • Search Google Scholar
    • Export Citation

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