Prevalence and Prognosis of Coronal Malalignment Following Lateral Lumbar Interbody Fusion for Minimally Invasive Treatment of Adult Spinal Deformity

Andrew K Chan; Shailen G Sampath; Praveen V Mummaneni; Paul Park; Juan S Uribe; Jay D Turner; Vivian P Le; Robert K Eastlack; Richard G Fessler; Khoi D Than; Kai-Ming Fu; Michael Y Wang; Adam S Kanter; David O Okonkwo; Pierce D Nunley; Neel Anand; Gregory M Mundis Jr; Peter G Passias; Shay Bess; Christopher I Shaffrey; Dean Chou; International Spine Study Group

doi:10.1097/BRS.0000000000005191

Prevalence and Prognosis of Coronal Malalignment Following Lateral Lumbar Interbody Fusion for Minimally Invasive Treatment of Adult Spinal Deformity

Spine (Phila Pa 1976). 2024 Nov 7. doi: 10.1097/BRS.0000000000005191. Online ahead of print.

Authors

Andrew K Chan¹, Shailen G Sampath¹, Praveen V Mummaneni², Paul Park³, Juan S Uribe⁴, Jay D Turner⁴, Vivian P Le¹, Robert K Eastlack⁵, Richard G Fessler⁶, Khoi D Than⁷, Kai-Ming Fu³, Michael Y Wang⁸, Adam S Kanter⁹, David O Okonkwo⁹, Pierce D Nunley¹⁰, Neel Anand¹¹, Gregory M Mundis Jr⁵, Peter G Passias¹², Shay Bess¹³, Christopher I Shaffrey⁷, Dean Chou¹; International Spine Study Group

Affiliations

¹ Department of Neurological Surgery, Columbia University, New York, NY, USA.
² Department of Neurological Surgery, University of California, San Francisco, CA, USA.
³ Department of Neurological Surgery, University of Tennessee; Semmes-Murphey Neurologic and Spine Institute, Memphis, TN, USA.
⁴ Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA.
⁵ Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA.
⁶ Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
⁷ Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
⁸ Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY, USA.
⁹ Department of Neurological Surgery, University of Miami, Miami, FL, USA.
¹⁰ Department of Neurosurgery, Hoag Pickup Family Neurosciences Institute, Newport Beach, CA.
¹¹ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
¹² Department of Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, LA, USA.
¹³ Department of Orthopedic Surgery, Cedars-Sinai Health Center, Los Angeles, CA, USA.

PMID: 39523665
DOI: 10.1097/BRS.0000000000005191

Abstract

Study design: Retrospective analysis of prospective multicenter adult spinal deformity (ASD) database.

Objective: To determine the prevalence and prognosis of postoperative coronal malalignment following LLIF for ASD with Qiu type A coronal alignment.

Summary of background data: Qiu Type A coronal alignment is defined as coronal vertical axis (CVA) <30mm.1 There is concern that circumferential minimally invasive surgery (cMIS) with lateral lumbar interbody fusion (LLIF) is associated with postoperative coronal malalignment in ASD with preoperative Qiu type A patients.

Methods: Qui type A patients undergoing cMIS with LLIF for ASD were included, with ASD defined with at least: maximum CC≥20°, SVA>5 cm, PI-LL≥10°, or PT>20°. Two year (2Y) clinical outcomes were compared for type A with 2Y CVA≥30 mm (MAL) versus <30 mm (ALIGN) and were adjusted for factors reaching P<0.05 on univariate comparisons (age, BMI, and ODI).

Results: 43 patients met inclusion criteria, of which 12 (27.9%) developed coronal malalignment and 31 (72.1%) remained coronally aligned at 2Y. At baseline, MAL were older (73.0 vs. 69.0, P=0.045), had a lower BMI (26.09 vs. 29.45, P=0.047), and were less disabled (ODI 42.83 vs. 51.69, P=0.016). Otherwise, the groups were well-matched for baseline characteristics. At 2Y, MAL had a greater 2Y SVA (mean 54.08 vs 19.00 mm, P=0.01). Clinically, MAL was associated with inferior 2Y SF-36 PCS (34.78 vs. 37.42, adj P=0.043) and 2Y SRS-22r function/activity domain (3.03 vs. 3.36, adj P=0.040), but otherwise similar in other patient-reported-outcome-metrics (adj P>0.05 for all). 2Y complications were similar between groups, including for reoperations and major and minor complications (adj P>0.05 for all).

Conclusions: In Qui type A patients undergoing cMIS with LLIF for ASD, 27.9% develop coronal malalignment, which was associated with worse SF-36 PCS and SRS-22r function/activity. Despite radiographic malalignment, malalignment was not associated with higher 2-year complication rates including reoperations.