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Clinical and Radiographic Evaluation of Multilevel Lateral Lumbar Interbody Fusion in Adult Degenerative Scoliosis

Katz, Austen D. BA; Singh, Hardeep MD; Greenwood, Matthew BS; Cote, Mark PT, DPT, MS, CTR; Moss, Isaac L. MD, MASc, FRCSC

doi: 10.1097/BSD.0000000000000812
PRIMARY RESEARCH
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Study Design: Retrospective review of prospective data.

Objective: The objective of this study was to describe the clinical, radiographic, and complication-related outcomes through ≥1-year of 27 patients who underwent lateral lumbar interbody fusion (LLIF) with posterior instrumentation to treat ≥3 contiguous levels of degenerative lumbar scoliosis.

Summary of Background Data: Multilevel disease has traditionally been treated with open posterior fusion. Literature on multilevel LLIF is limited. We present our experience with utilizing LLIF to treat multilevel degenerative scoliosis.

Methods: Clinical outcomes were evaluated using VAS, SF-12, and ODI. Radiographic outcomes included pelvic tilt, pelvic incidence, lumbar lordosis, pelvic incidence-lumbar lordosis mismatch, Cobb angle, and cage subsidence. Perioperative and long-term complications through the ≥1-year final-postoperative visit were reviewed; transient neurological disturbances were assessed independently. Demographic, comorbidity, operative, and recovery variables, including opioid use, were explored for association with primary outcomes.

Results: Mean time to final-postoperative visit was 22.5 months; levels treated with LLIF per patient, 3.7; age, 66 years; and lateral operative time, 203 minutes. EBL was ≤100 mL in 74% of cases. Clinical outcomes remained significantly improved at ≥1-year. Cobb angle was corrected from 21.1 to 7.9 degrees (P<0.001), lordosis from 47.3 to 52.6 degrees (P<0.001), and mismatch from 11.4 to 6.4 degrees (P=0.003). High-grade subsidence occurred in 3 patients. Subsidence did not significantly impact primary outcomes. In total, 11.1% returned to the operating room for complication-related intervention over nearly 2-years; 37% experienced complications. Experiencing a complication was associated with having an open-posterior portion (P=0.048), but not with number of LLIF levels treated, or with clinical or radiographic outcomes. No patients experienced protracted neurological deficits; psoas weakness was associated with increased lateral operative time (P=0.049) and decreased surgeon experience (P=0.028).

Conclusions: Patients who underwent multilevel LLIF with adjunctive posterior surgery had significant clinical and radiographic improvements. Complication rates were similar compared to literature on single-level LLIF. LLIF is a viable treatment for multilevel degenerative scoliosis.

Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut School of Medicine, Farmington, CT

IRB approval was obtained for this study. IRB Number: 17-109-2.

I.L.M.: is a consultant for NuVasive, the manufacturer of the interbody devices implanted in patients evaluated in this study. M.C.: reports personal fees from AANA. The remaining authors declare no conflict of interest.

Reprints: Isaac L. Moss, MD, MASc, FRCSC, Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, Comprehensive Spine Center, 263 Farmington Avenue, Farmington, CT 06030-5353 (e-mail: imoss@uchc.edu).

Received July 22, 2018

Accepted January 8, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.