Combination Treatment Effective for Adult Spinal Deformity

Two techniques are playing a new role in the treatment of adult spinal deformity, according to a recently published study.

“As technology advances, different tools for the treatment of adult spinal deformity are becoming available. The most recent interbody fusion technique, the lateral minimally invasive-lumbar interbody fusion (MI-LIF), shows great promise for treating mild and moderate severity adult spinal deformity,” Jotham C. Manwaring, M.D., and colleagues stated in their study. “The lateral MI-LIF combined with anterior column release (ACR) has the ability to correct sagittal balance (sagittal vertebral axis) by 3.1 cm and lumbar lordosis by 12 degrees at each treated level.”

Manwaring and colleagues conducted a preliminary retrospective radiographic review of prospectively collected data for 36 patients treated from 2009 to 2012 at a single institution.

According to the study, patient demographics and radiographic data were collected for nine patients who underwent MI-ACR and 27 patients who did not undergo MI-ACR. Patients (13 men and 23 women; mean age 64.3 years) had undergone at least a two-level MI-LIF procedure. Degenerative scoliosis was the primary diagnosis for all patients. The mean clinical follow-up for the non-ACR group was 22.9 months and 11.3 months for the ACR group.

Manwaring and colleagues noted that the MI-LIF surgical technique effectively created needed additional disc height and corrected coronal imbalance.

They concluded that percutaneous transpedicular spinal instrumentation did not significantly alter any of the spinopelvic parameters in either the ACR group or the non-ACR group. Lateral MI-LIF alone significantly improved the coronal Cobb angle by 16 degrees, and the fractional curve significantly improved in a subgroup of patients treated with L5-S1 transforaminal lumbar interbody fusion. Surgeons performed 15 ACRs in nine patients and this resulted in significant coronal Cobb angle correction; lumbar lordosis correction was 16.5 degrees and sagittal vertebral axis correction was 4.8 cm per patient, based on the results. The segmental analysis done by Manwaring and colleagues revealed a 12 degree gain in segmental lumbar lordosis and there was a 3.1 cm correction of the sagittal vertebral axis for each ACR level treated.