Combined Anterior–Posterior vs. Posterior-Only Approach in Adult Spinal Deformity Surgery: Which Strategy Is Superior?
<b>Introduction:</b> Whether a combined anterior–posterior (AP) approach offers additional benefits over the posterior-only (P) approach in adult spinal deformity (ASD) surgery remains unknown. In a cohort of patients undergoing ASD surgery, we compared the combined AP vs. the P-only app...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-01-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/13/3/682 |
| _version_ | 1797318573783252992 |
|---|---|
| author | Iyan Younus Hani Chanbour Jeffrey W. Chen Graham W. Johnson Tyler Metcalf Alexander T. Lyons Soren Jonzzon Campbell Liles Steven G. Roth Amir M. Abtahi Byron F. Stephens Scott L. Zuckerman |
| author_facet | Iyan Younus Hani Chanbour Jeffrey W. Chen Graham W. Johnson Tyler Metcalf Alexander T. Lyons Soren Jonzzon Campbell Liles Steven G. Roth Amir M. Abtahi Byron F. Stephens Scott L. Zuckerman |
| author_sort | Iyan Younus |
| collection | DOAJ |
| description | <b>Introduction:</b> Whether a combined anterior–posterior (AP) approach offers additional benefits over the posterior-only (P) approach in adult spinal deformity (ASD) surgery remains unknown. In a cohort of patients undergoing ASD surgery, we compared the combined AP vs. the P-only approach in: (1) preoperative/perioperative variables, (2) radiographic measurements, and (3) postoperative outcomes. <b>Methods:</b> A single-institution, retrospective cohort study was performed for patients undergoing ASD surgery from 2009 to 2021. Inclusion criteria were ≥5-level fusion, sagittal/coronal deformity, and 2-year follow-up. The primary exposure was the operative approach: a combined AP approach or P alone. Postoperative outcomes included mechanical complications, reoperation, and minimal clinically important difference (MCID), defined as 30% of patient-reported outcome measures (PROMs). Multivariable linear regression was controlled for age, BMI, and previous fusion. <b>Results:</b> Among 238 patients undergoing ASD surgery, 34 (14.3%) patients underwent the AP approach and 204 (85.7%) underwent the P-only approach. The AP group consisted mostly of anterior lumbar interbody fusion (ALIF) at L5/S1 (73.5%) and/or L4/L5 (38.0%). Preoperatively, the AP group had more previous fusions (64.7% vs. 28.9%, <i>p</i> < 0.001), higher pelvic tilt (PT) (29.6 ± 11.6° vs. 24.6 ± 11.4°, <i>p</i> = 0.037), higher T1 pelvic angle (T1PA) (31.8 ± 12.7° vs. 24.0 ± 13.9°, <i>p</i> = 0.003), less L1-S1 lordosis (−14.7 ± 28.4° vs. −24.3 ± 33.4°, <i>p</i> < 0.039), less L4-S1 lordosis (−25.4 ± 14.7° vs. 31.6 ± 15.5°, <i>p</i> = 0.042), and higher sagittal vertical axis (SVA) (102.6 ± 51.9 vs. 66.4 ± 71.2 mm, <i>p</i> = 0.005). Perioperatively, the AP approach had longer operative time (553.9 ± 177.4 vs. 397.4 ± 129.0 min, <i>p</i> < 0.001), more interbodies placed (100% vs. 17.6%, <i>p</i> < 0.001), and longer length of stay (8.4 ± 10.7 vs. 7.0 ± 9.6 days, <i>p</i> = 0.026). Radiographically, the AP group had more improvement in T1PA (13.4 ± 8.7° vs. 9.5 ± 8.6°, <i>p</i> = 0.005), L1-S1 lordosis (−14.3 ± 25.6° vs. −3.2 ± 20.2°, <i>p</i> < 0.001), L4-S1 lordosis (−4.7 ± 16.4° vs. 3.2 ± 13.7°, <i>p</i> = 0.008), and SVA (65.3 ± 44.8 vs. 44.8 ± 47.7 mm, <i>p</i> = 0.007). These outcomes remained statistically significant in the multivariable analysis controlling for age, BMI, and previous fusion. Postoperatively, no significant differences were found in mechanical complications, reoperations, or MCID of PROMs. <b>Conclusions:</b> Preoperatively, patients undergoing the combined anterior–posterior approach had higher PT, T1PA, and SVA and lower L1-S1 and L4-S1 lordosis than the posterior-only approach. Despite increased operative time and length of stay, the anterior–posterior approach provided greater sagittal correction without any difference in mechanical complications or PROMs. |
| first_indexed | 2024-03-08T03:54:17Z |
| format | Article |
| id | doaj.art-109fba29a570483591daf69e331caea7 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T03:54:17Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-109fba29a570483591daf69e331caea72024-02-09T15:15:34ZengMDPI AGJournal of Clinical Medicine2077-03832024-01-0113368210.3390/jcm13030682Combined Anterior–Posterior vs. Posterior-Only Approach in Adult Spinal Deformity Surgery: Which Strategy Is Superior?Iyan Younus0Hani Chanbour1Jeffrey W. Chen2Graham W. Johnson3Tyler Metcalf4Alexander T. Lyons5Soren Jonzzon6Campbell Liles7Steven G. Roth8Amir M. Abtahi9Byron F. Stephens10Scott L. Zuckerman11Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USADepartment of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USADepartment of Neurological Surgery, Baylor College of Medicine, Houston, TX 77030, USASchool of Medicine, Vanderbilt University, Nashville, TN 37232, USASchool of Medicine, Vanderbilt University, Nashville, TN 37232, USASchool of Medicine, Vanderbilt University, Nashville, TN 37232, USADepartment of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USADepartment of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USADepartment of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USADepartment of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USADepartment of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USADepartment of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA<b>Introduction:</b> Whether a combined anterior–posterior (AP) approach offers additional benefits over the posterior-only (P) approach in adult spinal deformity (ASD) surgery remains unknown. In a cohort of patients undergoing ASD surgery, we compared the combined AP vs. the P-only approach in: (1) preoperative/perioperative variables, (2) radiographic measurements, and (3) postoperative outcomes. <b>Methods:</b> A single-institution, retrospective cohort study was performed for patients undergoing ASD surgery from 2009 to 2021. Inclusion criteria were ≥5-level fusion, sagittal/coronal deformity, and 2-year follow-up. The primary exposure was the operative approach: a combined AP approach or P alone. Postoperative outcomes included mechanical complications, reoperation, and minimal clinically important difference (MCID), defined as 30% of patient-reported outcome measures (PROMs). Multivariable linear regression was controlled for age, BMI, and previous fusion. <b>Results:</b> Among 238 patients undergoing ASD surgery, 34 (14.3%) patients underwent the AP approach and 204 (85.7%) underwent the P-only approach. The AP group consisted mostly of anterior lumbar interbody fusion (ALIF) at L5/S1 (73.5%) and/or L4/L5 (38.0%). Preoperatively, the AP group had more previous fusions (64.7% vs. 28.9%, <i>p</i> < 0.001), higher pelvic tilt (PT) (29.6 ± 11.6° vs. 24.6 ± 11.4°, <i>p</i> = 0.037), higher T1 pelvic angle (T1PA) (31.8 ± 12.7° vs. 24.0 ± 13.9°, <i>p</i> = 0.003), less L1-S1 lordosis (−14.7 ± 28.4° vs. −24.3 ± 33.4°, <i>p</i> < 0.039), less L4-S1 lordosis (−25.4 ± 14.7° vs. 31.6 ± 15.5°, <i>p</i> = 0.042), and higher sagittal vertical axis (SVA) (102.6 ± 51.9 vs. 66.4 ± 71.2 mm, <i>p</i> = 0.005). Perioperatively, the AP approach had longer operative time (553.9 ± 177.4 vs. 397.4 ± 129.0 min, <i>p</i> < 0.001), more interbodies placed (100% vs. 17.6%, <i>p</i> < 0.001), and longer length of stay (8.4 ± 10.7 vs. 7.0 ± 9.6 days, <i>p</i> = 0.026). Radiographically, the AP group had more improvement in T1PA (13.4 ± 8.7° vs. 9.5 ± 8.6°, <i>p</i> = 0.005), L1-S1 lordosis (−14.3 ± 25.6° vs. −3.2 ± 20.2°, <i>p</i> < 0.001), L4-S1 lordosis (−4.7 ± 16.4° vs. 3.2 ± 13.7°, <i>p</i> = 0.008), and SVA (65.3 ± 44.8 vs. 44.8 ± 47.7 mm, <i>p</i> = 0.007). These outcomes remained statistically significant in the multivariable analysis controlling for age, BMI, and previous fusion. Postoperatively, no significant differences were found in mechanical complications, reoperations, or MCID of PROMs. <b>Conclusions:</b> Preoperatively, patients undergoing the combined anterior–posterior approach had higher PT, T1PA, and SVA and lower L1-S1 and L4-S1 lordosis than the posterior-only approach. Despite increased operative time and length of stay, the anterior–posterior approach provided greater sagittal correction without any difference in mechanical complications or PROMs.https://www.mdpi.com/2077-0383/13/3/682adult spinal deformityanterior–posteriorposterior onlyapproachsagittal malalignmentoutcomes |
| spellingShingle | Iyan Younus Hani Chanbour Jeffrey W. Chen Graham W. Johnson Tyler Metcalf Alexander T. Lyons Soren Jonzzon Campbell Liles Steven G. Roth Amir M. Abtahi Byron F. Stephens Scott L. Zuckerman Combined Anterior–Posterior vs. Posterior-Only Approach in Adult Spinal Deformity Surgery: Which Strategy Is Superior? Journal of Clinical Medicine adult spinal deformity anterior–posterior posterior only approach sagittal malalignment outcomes |
| title | Combined Anterior–Posterior vs. Posterior-Only Approach in Adult Spinal Deformity Surgery: Which Strategy Is Superior? |
| title_full | Combined Anterior–Posterior vs. Posterior-Only Approach in Adult Spinal Deformity Surgery: Which Strategy Is Superior? |
| title_fullStr | Combined Anterior–Posterior vs. Posterior-Only Approach in Adult Spinal Deformity Surgery: Which Strategy Is Superior? |
| title_full_unstemmed | Combined Anterior–Posterior vs. Posterior-Only Approach in Adult Spinal Deformity Surgery: Which Strategy Is Superior? |
| title_short | Combined Anterior–Posterior vs. Posterior-Only Approach in Adult Spinal Deformity Surgery: Which Strategy Is Superior? |
| title_sort | combined anterior posterior vs posterior only approach in adult spinal deformity surgery which strategy is superior |
| topic | adult spinal deformity anterior–posterior posterior only approach sagittal malalignment outcomes |
| url | https://www.mdpi.com/2077-0383/13/3/682 |
| work_keys_str_mv | AT iyanyounus combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior AT hanichanbour combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior AT jeffreywchen combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior AT grahamwjohnson combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior AT tylermetcalf combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior AT alexandertlyons combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior AT sorenjonzzon combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior AT campbellliles combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior AT stevengroth combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior AT amirmabtahi combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior AT byronfstephens combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior AT scottlzuckerman combinedanteriorposteriorvsposterioronlyapproachinadultspinaldeformitysurgerywhichstrategyissuperior |