Resident Physician UCSF Department of Neurosurgery San Francisco, California, United States
Disclosure(s):
Alexa Semonche, MD: No financial relationships to disclose
Introduction: Transforaminal lumbar interbody fusion (TLIF) and lateral anterior lumbar interbody fusion (ALIF) are both utilized at the lumbosacral junction during surgery for adult spinal deformity. We sought to describe and compare changes in spinopelvic parameters and Global Alignment and Proportion (GAP) score in patients undergoing lateral ALIF versus TLIF at L5-S1 plus posterior spinal fusion (PSF).
Methods: Retrospective chart review of patients undergoing either lateral ALIF or TLIF at L5-S1 plus PSF from T10 or higher to the pelvis, with or without extreme lateral interbody fusion (XLIF) at additional levels. Spinopelvic parameters (pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), Lumbar 1-Sacral 1 lordosis (L1-S1 LL), Lumbar 4-sacral 1 lordosis (L4-S1 LL), sagittal vertical axis (SVA)) and GAP score were determined from pre- and post-operative scoliosis X-ray films for each patient. Mean preoperative, postoperative, and change in values were compared between patients undergoing lateral ALIF versus TLIF at L5-S1. Rates of proximal junctional kyphosis (PJK) were also compared.
Results: Between 2017-2024, 17 patients underwent lateral L5-S1 ALIF plus PSF/XLIFs and 24 patients underwent L5-S1 TLIF plus PSF/XLIFs. The average age at time of surgery did not significantly differ between the lateral ALIF and TLIF groups (65.5 +/- 6.2 years vs. 67.3 +/- 6.7 years, respectively). Baseline preoperative values for all spinopelvic parameters and GAP score did not differ significantly between the lateral ALIF and TLIF groups (P>0.05). The change in L4-S1 lordosis was greater in the lateral ALIF group compared to the TLIF group (14.3°+/- 12.8° vs. 5.0°+/- 6.4°, P=0.003). However, changes in L1-S1 lordosis, GAP score, and SVA were similar between both groups (P>0.05). GAP score achieved postoperatively was also similar between groups (lateral ALIF: 4.2+/- 3.8, TLIF: 5.03+/- 7.3, P=0.5). The rate of PJK was 12% in the lateral ALIF group compared to 21% in the TLIF group (P>0.05).
Conclusion : Adult spinal deformity patients undergoing lateral ALIF at L5-S1 had a significantly greater increase in L4-S1 lumbar lordosis compared to those undergoing TLIF at L5-S1. The degree of change in other spinopelvic parameters and GAP score was similar between groups. Both methods can be utilized successfully in deformity correction.