glenn r. buttermann, md xlif vs alif combined with psf results in a community practice 1
TRANSCRIPT
Introduction• XLIF combined with posterior spinal fusion has increased in
popularity for patients with advanced degenerative spinal conditions as well as selective deformity conditions.
• Prior studies have predominantly been from academic institutions or by authors who had a financial relationship to a manufacturer with the potential for bias in reported outcomes.
• The purpose of this study was to assess outcomes of an XLIF cohort and compare to a previous prospective cohort of traditional 2-level anterior/posterior spinal fusion patients treated for advanced degenerative disc disease.
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Present Study• Indications for XLIF patient (n=41) were primary surgical fusion
for lumbar DDD, adjacent segment degenerative condition, or as part of a hybrid procedure for spinal deformity.
• Prospective study: Visual Analog Scale for back pain and leg pain, pain drawing, ODI.
• Follow-up periods were at six-month to one year intervals with minimum two-year follow-up.
• Comparative anterior/posterior spinal fusion cohort (n=50) had similar prospective outcomes evaluation.
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XLIF/PSF vs ASF/PSF
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Age (mean +/- SD) 59.1 ± 18.8 44.0 ± 11.5Female (%) 78 68Smokers (%) 10 50Work Comp/Lit (%) 5 48Osteoporosis (%) 24 36EBL (ml, mean +/- SD) 283 ± 188 498 ± 297
XLIF/PSF ASF/PSF
Major XLIF Dx• Adjacent segment degenerative condition
Example: L23 Adj DDD/stenosis/retrolisthesisPreop Postop
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Low Back & Leg Pain Outcomes
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0
2
4
6
8
10
PRE-OP 7-12 MONTH 1-2 YEARS 2-4 YEARS
VA
S
FOLLOW-UP PERIOD
Fig. 1, BACK PAIN
XLIF/PSF (n=41)
ASF/PSF (n=50)
0
2
4
6
8
10
PRE-OP 7-12 MONTH 1-2 YEARS 2-4 YEARS
VA
S
FOLLOW-UP PERIOD
Fig. 2, LEG PAIN
XLIF/PSF (n=41)
ASF/PSF (n=50)
Pain Drawing & ODI Outcomes
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02468
101214161820
PRE-OP 7-12 MONTH 1-2 YEARS 2-4 YEARS
PA
IN
AR
EA
FOLLOW-UP PERIOD
Fig. 3, PAIN DRAWING
XLIF/PSF (n=41)
ASF/PSF (n=50)
0
10
20
30
40
50
60
70
80
PRE-OP 7-12 MONTH 1-2 YEARS 2-4 YEARS
Deg
ree
of
Dis
abili
ty
FOLLOW-UP PERIOD
Fig. 4, OSWESTRY DISABILITY
XLIF/PSF (n=41)
ASF/PSF (n=50)
Results• Most common indication for XLIF was adjacent level
degenerative condition s/p prior lumbar fusion (29 of 41 patients).
• Both XLIF/PSF and ASF/PSF groups had significantly improved outcomes at all follow-up periods.
• There was no significant difference in outcomes between XLIF/PSF and ASF/PSF groups, however demographics differ between cohorts.
• Patients in both XLIF and AP fusion groups who had interbody device subsidence were found to have osteoporosis.
• Transient neurological deficits were most common at L4-5 in the XLIF cohort.
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Discussion• The outcomes of XLIF combined with PSF were
statistically similar to ASF/PSF outcomes in patients undergoing primary fusion.
• The XLIF approach avoids potential complications related to revision ASF approach in patients who have adjacent level conditions yet obtains similar clinical success.
• Patients with osteoporosis require additional individualized treatment:
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Subsidence in osteoporotic pt.