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Efficacy of lateral lumbar interbody fusion combined with posterior spinal fusion compared with three-column osteotomy for adult spinal deformity with severe lumbar sagittal deformity.

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Abstract

Purpose

The clinical and radiological results of adult spinal deformity (ASD) patients with a severe lumbar sagittal deformity undergoing multilevel lateral lumbar interbody fusion (LLIF) + posterior spinal fusion (PSF) were compared to patients undergoing three-column osteotomy (3CO).

Methods

We defined severe lumbar sagittal deformity as fulcrum backward bending (FBB) pelvic incidence minus lumbar lordosis (PI-LL) ≧ 20 degrees. A total of twenty-five patients with an ASD were enrolled between 2013 and 2018. Fifteen patients were in the LLIF + PSF group, and ten patients were in the 3CO group. We evaluated patient demographics, clinical outcomes, and radiographic parameters such as the Cobb angle and spinopelvic parameters from standing X-ray films in each group.

Results

The LLIF + PSF group had a significantly shorter follow-up time than the 3CO group. Postoperatively, the LLIF + PSF group had significantly lower PI-LL and a shorter sagittal vertical axis than the 3CO group. Postoperative PI-LL changes in the LLIF + PSF group were significantly smaller than those in the 3CO group. There were no differences in other patient demographics, radiographic parameters, or clinical outcomes between the groups.

Conclusion

Multilevel LLIF + PSF improved the PI-LL and SVA more than did 3CO for ASD patients with severe lumbar sagittal deformity. This indicated that the multilevel LLIF with open PSF can provide good clinical outcomes even in cases with severe lumbar sagittal deformity such as large FBB PI-LL in which 3CO techniques usually are needed.

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Data availability

The datasets acquired and analysed in this study will be disclosed by the corresponding author on reasonable request.

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Acknowledgement

IRB Approval: No. 2020007, Institutional review board of Seirei Sakura Citizen Hospital.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai, Sakura, Chiba, 286-8765, Japan

    Tsuyoshi Sakuma, Toshiaki Kotani, Tsutomu Akazawa, Keita Nakayama, Yasushi Iijima, Shunji Kishida, Yuta Muramatsu, Yu Sasaki, Keisuke Ueno & Shohei Minami

  2. Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan

    Tsutomu Akazawa

  3. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Seiji Ohtori

Authors
  1. Tsuyoshi Sakuma
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  2. Toshiaki Kotani
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  3. Tsutomu Akazawa
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  4. Keita Nakayama
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  5. Yasushi Iijima
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  6. Shunji Kishida
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  7. Yuta Muramatsu
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  8. Yu Sasaki
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  9. Keisuke Ueno
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  10. Seiji Ohtori
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  11. Shohei Minami
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Contributions

Tsuyoshi Sakuma wrote and prepared the manuscript, and all of the authors participated in the study design. All authors have read, reviewed, and approved the article.

Corresponding author

Correspondence to Tsuyoshi Sakuma.

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Informed consent was obtained by all participants in this study.

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Sakuma, T., Kotani, T., Akazawa, T. et al. Efficacy of lateral lumbar interbody fusion combined with posterior spinal fusion compared with three-column osteotomy for adult spinal deformity with severe lumbar sagittal deformity.. Eur J Orthop Surg Traumatol 32, 973–979 (2022). https://doi.org/10.1007/s00590-021-03068-z

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  • DOI: https://doi.org/10.1007/s00590-021-03068-z

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