No increase in complication rates using ACR when compared to LLIF

Senior author Praveen Mummaneni

The results of a recent study indicate that anterior column realignment (ACR) via a lateral approach allows for the normalisation of spinopelvic parameters without additive complication risk when compared to lateral lumbar interbody fusion (LLIF).

Presenting author Praveen Mummaneni (University of California, San Francisco, USA) announced this conclusion at the 26th International Meeting on Advanced Spine Techniques (IMAST 2019; 17–20 July, Amsterdam, The Netherlands), sponsored by the Scoliosis Research Society.

The authors note that prior to this prospective multicentre review, it was known that ACR can be utilised for correction of ASD, but that the additional benefit over LLIF alone was unclear.

In this prospective, multicentre review, the investigators found that use of ACR via a lateral approach for correction of adult spinal deformity (ASD) results in no increase in neurologic, vascular, or other overall complication rates, when compared to using LLIF. However, they added that ACR is a more complex procedure and should be performed only by highly experienced surgeons.

In addition, they note that optimisation of spinopelvic parameters was achieved regardless of the technique employed, and while segmental radiographic changes were not specifically evaluated, regional and global parameters were not differentially impacted when comparing ACR and LLIF impact. However, patients undergoing ACR did have a greater improvement in sagittal vertical axis (SVA) compared to those who underwent LLIF.

Mummaneni and colleagues included in the study patients 18 years old and above, and with either a coronal cobb of greater than 20 degrees, an SVA of more than 5cm, a PT of greater than 20 degrees, or a PI-LL of above 10 degrees. Patients were treated with either circumferential minimally invasive surgery (cMIS) or hybrid MIS, with follow-up of at least one year. HRQOL, including Oswestry Disability Index (ODI), visual analogue score [VAS], and SRS-22, as well as spinopelvic parameters, were captured.

A total of 127 patients met the inclusion criteria for the study, including 101 who underwent LLIF and 26 who underwent ACR. The average age of the LLIF group was 66.3, compared to a slightly higher average of 67.8 in the ACR group. The average BMI of both groups was similar—27.7 in the LLIF group and 27.4 in the ACR cohort.

The groups had similar rates of prior spine surgery (48.5% vs. 57.7%), cMIS (58.7% vs. 73.1%), posterior osteotomies (43.6% vs. 34.6%), levels instrumented (7.8 vs. 8), and interbody fusion levels (3.4 vs. 3.6). In addition, preoperative and postoperative spinopelvic parameters were similar between groups, except for postoperative SVA, which was higher in the LLIF group. Preoperative and postoperative ODI, VAS, and SRS-22 scores were also similar between both groups.

Complication rates between groups were also similar (57.4% LLIF vs. 57.7% ACR), including neurologic (16.8% vs. 15.4%) and vascular (0% for both groups) injuries.


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