Restoring L4-S1 Lordosis Shape in Severe Sagittal Deformity: Impact of Correction Techniques on Alignment and Complication Profile.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Singh Manjot, Balmaceno-Criss Mariah, Daher Mohammad, Lafage Renaud, Hamilton D Kojo, Smith Justin S, Eastlack Robert K, Fessler Richard G, Gum Jeffrey L, Gupta Munish C, Hostin Richard, Kebaish Khaled M, Klineberg Eric O, Lewis Stephen J, Line Breton G, Nunley Pierce D, Mundis Gregory M, Passias Peter G, Protopsaltis Themistocles S, Buell Thomas, Ames Christopher P, Mullin Jeffrey P, Soroceanu Alex, Scheer Justin K, Lenke Lawrence G, Bess Shay, Shaffrey Christopher I, Schwab Frank J, Lafage Virginie, Burton Douglas C, Diebo Bassel G, Daniels Alan H, International Spine Study Group
Аннотация
METHODS: Severe adult spinal deformity patients with preoperative PI-LL >20°, L4-S1 lordosis <30°, and full body radiographs and PROMs at baseline and 6-week postoperative visit were included. Patients were grouped into ALIF (1-2 level ALIF at L4-S1), PSO (L4/L5 PSO), and TLIF (1-2 level TLIF at L4-S1). Comparative analyses were performed on demographics, radiographic spinopelvic parameters, complications, and PROMs.
RESULTS: Among the 96 included patients, 40 underwent ALIF, 27 underwent PSO, and 29 underwent TLIF. At baseline, cohorts had comparable age, sex, race, Edmonton frailty scores, and radiographic spinopelvic parameters (P > 0.05). However, PSO was performed more often in revision cases (P < 0.001). Following surgery, L4-S1 lordosis correction (P = 0.001) was comparable among ALIF and PSO patients and caudal lordotic apex migration (P = 0.044) was highest among ALIF patients. PSO patients had higher intraoperative estimated blood loss (P < 0.001) and motor deficits (P = 0.049), and in-hospital ICU admission (P = 0.022) and blood products given (P = 0.004), but were otherwise comparable in terms of length of stay, blood transfusion given, and postoperative admission to rehab. Likewise, 90-day postoperative complication profiles and 6-week PROMs were comparable as well.
CONCLUSIONS: ALIF can restore L4-S1 sagittal alignment as powerfully as PSO, with fewer intraoperative and in-hospital complications. When feasible, ALIF is a suitable alternative to PSO and likely superior to TLIF for correcting L4-S1 lordosis among patients with severe sagittal malalignment.