Introduction: There are myriad options for approaching the spine for fusion in the correction of scoliosis, including the front(anterior), back(posterior), and side(lateral). Minimally invasive scoliosis surgeries are often staged, wherein anterior and/or lateral lumbar interbody fusion is followed by percutaneous (through the skin) posterior fixation days later. This study examines the impact on outcomes when posterior fixation was delayed due to unexpected medical issues following the first stage, anterolateral procedure.
The Study: A retrospective review was conducted of all patients undergoing minimally invasive circumferential deformity corrections from 2006 to 2019. Patients in whom planned posterior fixation was postponed due to medical necessity or safety concerns were identified. Perioperative surgical metrics and radiographic parameters were collected.
Key Findings: Three of the six patients initially scheduled for circumferential fusion never underwent posterior augmentation due to symptomatic improvement (2.3, 5, and 10.7 years of follow-up). The other three underwent posterior fixation once medically optimized after an average interval of 4.7 months (range 3.2-7.8 months) due to persistent symptoms. It was also observed that the average coronal malalignment in the postoperative period was 5.1 cm in the group requiring further fixation and only 1.6 cm in the group which did not.
Conclusion: In select cases, the indirect decompression and stability conferred by minimally invasive anterior or lateral interbody fusion alone may afford adequate pain relief to delay or even avoid posterior fixation in patients with adult spinal deformity.
Implications: This research offer valuable insights for individuals and medical experts evaluating the feasibility of stand-alone anterolateral interbody fusion as a therapeutic approach. The notable enhancements seen in the health, pain management, and disability parameters provide optimism for those battling lumbar spinal disorders. Persistent investigation in this sector is crucial to deepen our knowledge and aid in boosting the life quality for those impacted by spinal ailments and back pain.
The complete study can be found in the journal: Spine Deformity.
Citation:
Agarwal N, Roy S, Lavadi RS, et al. Durability of stand-alone anterolateral interbody fusion in staged minimally invasive circumferential scoliosis surgery with delayed posterior instrumentation due to medical necessity [published online ahead of print, 2023 Aug 1]. Spine Deform. 2023;10.1007/s43390-023-00725-7. doi:10.1007/s43390-023-00725-7
