Does L5-S1 Anterior Lumbar Interbody Fusion Improve Sagittal Alignment or Fusion Rates in Long Segment Fusion for Adult Spinal Deformity?

Andrew J. Meyers, Joseph B. Wick, Pope Rodnoi, Ahsan Khan, Eric O. Klineberg

Research output: Contribution to journalArticle

Abstract

Study Design: Retrospective cohort study. Objectives: To assess whether the addition of L5-S1 anterior lumbar interbody fusion (ALIF) improves global sagittal alignment and fusion rates in patients undergoing multilevel spinal deformity surgery. Methods: Two-year radiographic outcomes, including lumbar lordosis, pelvic incidence, pelvic tilt, and T1 pelvic angle; hardware complications; and nonunion/pseudarthrosis rates were compared between patients who underwent lumbosacral fusion at 4 or more vertebral levels with and without L5-S1 ALIF between November 2003 and September 2016. Results: A total of 51 patients who underwent fusion involving a mean of 11.1 levels with minimum 2-year postoperative radiographic follow-up data were included. Patients who underwent L5-S1 ALIF did not have significant improvement in global sagittal alignment parameters and demonstrated a trend toward a higher rate of nonunion and hardware failure. Conclusions: L5-S1 ALIF did not confer significant benefit in terms of global sagittal alignment and fusion rates in patients undergoing multilevel lumbosacral fusion. Given these results and that L5-S1 ALIF is associated with increased surgical morbidity, surgeons should be judicious in including L5-S1 ALIF in large multilevel constructs.

Original languageEnglish (US)
JournalGlobal Spine Journal
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • deformity
  • degenerative
  • failed back surgery
  • lumbar interbody fusion
  • pseudarthrosis
  • sagittal alignment
  • sagittal balance
  • scoliosis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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