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Moderate sagittal plane deformity patients have similar radiographic and functional outcomes with either anterior or posterior surgery

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Abstract

Purpose

This study aimed to compare the functional and radiographic outcomes of two surgical interventions for adult spinal deformity (ASD): anterior lumbar interbody fusion with anterior column realignment (ALIF-ACR) and posterior approach using Smith–Peterson osteotomy with transforaminal lumbar interbody fusion and pedicle screw fixation (TLIF-Schwab2).

Methods

A retrospective cohort study included 61 ASD patients treated surgically between 2019 and 2020 at a single tertiary orthopedic specialty hospital. Patients were divided into two groups: Group 1 (ALIF-ACR, 29 patients) and Group 2 (TLIF-Schwab2, 32 patients). Spinopelvic radiographic parameters and functional outcomes were evaluated at 3, 6, and 12 months postsurgery.

Results

Perioperative outcomes favored the ALIF-ACR group, with significantly smaller blood loss, shorter hospital stay, and operative time. Radiographic and functional outcomes were similar for both groups; however, the ALIF-ACR group did have a greater degree of correction in lumbar lordosis at 12 months. Complication profiles varied, with the ALIF-ACR group experiencing mostly hardware-related complications, while the TLIF-Schwab2 group faced dural tears, wound dehiscence, and proximal junctional kyphosis. Both groups had similar revision rates.

Conclusion

Both ALIF-ACR and TLIF-Schwab2 achieved similar radiographic and functional outcomes in ASD patients with moderate sagittal plane deformity at 1-year follow-up. However, the safety profiles of the two techniques differed. Further research is required to optimize patient selection for each surgical approach, aiming to minimize perioperative complications and reoperation rates in this challenging patient population.

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Authors and Affiliations

  1. Hospital Quironsalud San Jose, Madrid, Spain

    Anton Denisov

  2. 12 de Octubre University Hospital, Madrid, Spain

    Anton Denisov

  3. San Francisco Orthopaedic Residency Program and St. Mary’s Medical Center, 450 Stanyan St., San Francisco, CA, 94117, USA

    Andrea Rowland & Dimitriy Kondrashov

  4. Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia

    Nikita Zaborovskii & Dmitrii Ptashnikov

  5. Saint-Petersburg State University, Saint-Petersburg, Russia

    Nikita Zaborovskii

  6. North-Western State Medical University named after I. I. Mechnikov, Saint-Petersburg, Russia

    Dmitrii Ptashnikov

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  1. Anton Denisov
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  2. Andrea Rowland
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Correspondence to Andrea Rowland.

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DK is a consultant for Spineart and SI Bone and receives royalties from Spineart that are not related to this study. Other authors do not have conflicts of interest to report.

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Denisov, A., Rowland, A., Zaborovskii, N. et al. Moderate sagittal plane deformity patients have similar radiographic and functional outcomes with either anterior or posterior surgery. Eur Spine J 33, 620–629 (2024). https://doi.org/10.1007/s00586-023-08075-8

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  • DOI: https://doi.org/10.1007/s00586-023-08075-8

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