21. Comparison of spinopelvic parameters of multilevel TLIF and 360 lumbar fusion adult spinal deformity procedures via UNiD technology

Abstract

BACKGROUND CONTEXT

The goal of surgical treatment for patients with ASD is to achieve sagittal and coronal balance, relieve axial pain, and achieve fusion. Attaining normative ranges of spinopelvic parameters, such as sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT) has exhibited improved patient outcomes. Prior studies employing patient-specific rods, through UNiD Artificial Spine Intelligence, have demonstrated a statistically significant correlation between postoperative and predicted spinopelvic alignment with correction of SVA, PI-LL, and lumbar lordosis (LL) maintained at 2 years postoperatively. However, the most optimal surgical approach to attain optimal alignment remains inconclusive.

PURPOSE

To compare the correction of spinopelvic parameters of patients who have undergone adult spinal deformity (ASD) surgery with either transforaminal lumbar interbody fusion (TLIF) approach or a posterior approach and anterior lumbar interbody fusion (ALIF+PSF) by employing artificial intelligence (AI) guided preoperative surgical plan to generate patient-specific UNiD rods.

STUDY DESIGN/SETTING

Single-center retrospective cohort study.

PATIENT SAMPLE

The study cohort included patients who underwent spinal deformity surgery with patient specific UNiD rods with either a TLIF or ALIF + PSF approach.

OUTCOME MEASURES

Sagittal spinopelvic parameters sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence and lumbar lordosis mismatch (PI-LL) measured by EOS scans preoperatively, during planning, and postoperatively.

METHODS

Fourteen patients underwent ASD surgery (TLIF = 9, ALIF+PSF = 5). Independent 2-sample t-tests of (Postoperative - Planned) (Postoperative - Preoperative) were analyzed for all spinopelvic parameters (p< 0.05). Each variable was similarly compared with univariate analysis for ALIF and TLIF groups. Postoperative data analyzed at 1 year postoperatively.

RESULTS

The TLIF group reported ideal alignment with PT < 20° and PI-LL < 10° in 89% and 78% of the population respectively. The ALIF+PSF group reported ideal alignment with PT < 20° and PI-LL < 10° in 80% of the population (p = .891). The TLIF group presented with significantly greater lordosis correction compared to the ALIF group from the postoperative-preoperative perspective (12.89 ± 11.62 vs 5.2 ± 3.97) (p = .049). There was no statistical difference in PT, PI-LL and PI. Despite smaller spinopelvic differences (Postoperative-Planned) in the ALIF-PSF group, statistical significance was also not present.

CONCLUSIONS

In patients undergoing ASD surgery with patient-specific UNiD rods, the TLIF group revealed a statistically greater correction of lordosis than the ALIF. As such, this may demonstrate the superiority of this approach in sagittal correction. However, normative sagittal and spinopelvic alignment was achieved without statistical significance in both groups, exemplifying the appropriateness of both procedures to reach the goals of ASD surgery. Such findings highlight the difference in outcomes radiographically for TLIF and ALIF+PSF procedures that need to be researched further in multicenter prospective studies to identify the most optimal procedure for attaining optimal spinopelvic alignment.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.