27 - What is the Prevalence and Prognosis of Coronal Malalignment Following LLIF for Adult Spinal Deformity With Qiu Type A Coronal Alignment?

Friday, June 2, 2023

11:02 AM – 11:06 AM

Location: Salons 13-15

Co-Author(s)

AC

Andrew K. Chan, MD

Assistant Professor of Neurological Surgery (in Orthopaedic Surgery)
Columbia University
New York, New York, United States
PM

Praveen V. Mummaneni, MD, MBA

Professor
University of California San Francisco
san francisco, California, United States
PP

Paul Park, MD

United States
JU

Juan S. Uribe, M.D.

Chief of Spinal Disorders
Barrow Neurological Institute
phoenix, Arizona, United States
JT

Jay D. Turner, M.D., Ph.D.

Neurosurgeon
Barrow Neurological Institute
Phoenix, Arizona, United States

Presenting Author (Person doing the Podium Present(s)

VL

Vivian P. Le, M.P.H.

Columbia University Irving Medical Center, United States

Co-Author(s)

Robert K. Eastlack, M.D.

Partner, Spine Section, Division of Orthopaedic Surgery
Scripps Clinic
La Jolla, California, United States
RF

Richard G. Fessler, M.D., Ph.D.

Professor
Rush University Medical Center
Chicago, Illinois, United States
KF

Kai-Ming Fu, M.D., Ph.D.

Weil Cornell Medical Center, United States
MW

Michael Y. Wang, MD

Professor
University of Miami Department of Neurosurgery
Miami, Florida, United States
AK

Adam S. Kanter, M.D.

Hoag Pickup Family Neurosciences Institute, United States
DO

David O. Okonkwo, M.D., Ph.D.

University of Pittsburgh Medical Center, United States
Pierce D. Nunley, MD

Director
Spine Insitute of Louisiana
Shreveport, Louisiana, United States
NA

Neel Anand, MD

Medical Director: Spine Center
Cedars Sinai Medical Center
Los Angeles, California, United States
Gregory M. Mundis, Jr., M.D.

Director San Diego Spine Fellowship
Scripps Clinic
Encinitas, California, United States
PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States
SB

Shay Bess, M.D.

Spine surgeon
Denver International Spine Center
castle rock, Colorado, United States
CS

Christopher I. Shaffrey, Sr., MD

Duke University Medical Center
Durham, North Carolina, United States
DC

Dean Chou, MD

Columbia University, United States

Submitter(s)

AC

Andrew K. Chan, MD

Assistant Professor of Neurological Surgery (in Orthopaedic Surgery)
Columbia University
New York, New York, United States

Disclosure(s):

Robert K. Eastlack, M.D.: No relevant disclosure to display

Peter G. Passias, M.D.: No relevant disclosure to display

Introduction: Qiu Type A (QTA) coronal alignment is defined as coronal vertical axis (CVA) less than 30 mm. In adult spinal deformity (ASD) with QTA, it is unclear how circumferential minimally invasive surgery (cMIS) with lateral lumbar interbody fusion (LLIF) associates with postoperative coronal malalignment (CM) and clinical outcomes.

Aims/

Objectives: Circumferential minimally invasive surgery (cMIS) with lateral lumbar interbody fusion (LLIF) may associate with coronal malalignment (CM) in Qiu Type A coronal alignment.

Methods: This was a retrospective analysis of a prospective multicenter adult spinal deformity (ASD) database. Patients undergoing cMIS with LLIF for ASD with CM < 30 mm were included. Clinical outcomes were compared for QTA with 2-year (2Y) CVA≥30 mm (MAL) versus < 30 mm (ALIGN) and were adjusted for factors reaching p< 0.05 on univariate comparisons (age, BMI, and ODI).

Results: Eighty-five patients reached 2-year follow-up—43 met prespecified inclusion criteria. Overall, 12 (27.9%) patients developed CM at 2Y. MAL were older (73.0 vs. 69.0, p=0.045) and had lower BMI (26.1 vs. 29.5, p=0.047). MAL were less disabled at baseline (ODI 42.8 vs. 51.7, p=0.016). Otherwise, the groups were well matched, including SVA, CVA, and surgical characteristics. At 2Y, MAL had greater mean CVA (43.2 vs. 11.5 mm, adj-p < 0.001) and worsening in CVA (ΔCVA:+26.1 vs. -1.0 mm, adj-p < 0.001) compared to ALIGN, respectively. Clinically, MAL was associated with inferior 2Y SF-36 PCS (34.8 vs. 37.4, adj-p=0.043) and 2Y SRS-22r function/activity domain (3.0 vs. 3.4, adj-p=0.040), but otherwise similar 2Y ODI, NRS Back Pain, NRS Leg Pain, EQ-5D, EQ-5D VAS, SF-36 MCS, and SRS-22r total score (adj-p>0.05 for all). 2Y complications were similar between MAL and ALIGN, including for reoperations and both major and minor complications (adj-p>0.05 for all).

Conclusion: In patients undergoing cMIS with LLIF for ASD who are coronally aligned at baseline (Qiu Type A), approximately 27.9% develop CM. CM was associated with worse SF-36 PCS and SRS-22r function/activity. Despite malalignment, MAL was not associated with worse 2-year complication rates.