{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:25Z","timestamp":1787025745823,"version":"build-2736575974"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2017,2]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The aim of this study was to evaluate the utility of supplementing long thoracolumbar posterior instrumented fusion (posterior spinal fusion, PSF) with lateral interbody fusion (LIF) of the lumbar\/thoracolumbar coronal curve apex in adult spinal deformity (ASD).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Two multicenter databases were evaluated. Adults who had undergone multilevel LIF of the coronal curve apex in addition to PSF with L5\u2013S1 interbody fusion (LS+Apex group) were matched by number of posterior levels fused with patients who had undergone PSF with L5\u2013S1 interbody fusion without LIF (LS-Only group). All patients had at least 2 years of follow-up. Percutaneous PSF and 3-column osteotomy (3CO) were excluded. Demographics, perioperative details, radiographic spinal deformity measurements, and HRQoL data were analyzed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Thirty-two patients were matched (LS+Apex: 16; LS: 16) (6 men, 26 women; mean age 63 \u00b1 10 years). Overall, the average values for measures of deformity were as follows: Cobb angle > 40\u00b0, sagittal vertical axis (SVA) > 6 cm, pelvic tilt (PT) > 25\u00b0, and mismatch between pelvic incidence (PI) and lumbar lordosis (LL) > 15\u00b0. There were no significant intergroup differences in preoperative radiographic parameters, although patients in the LS+Apex group had greater Cobb angles and less LL. Patients in the LS+Apex group had significantly more anterior levels fused (4.6 vs 1), longer operative times (859 vs 379 minutes), and longer length of stay (12 vs 7.5 days) (all p < 0.01). For patients in the LS+Apex group, Cobb angle, pelvic tilt (PT), lumbar lordosis (LL), PI-LL (lumbopelvic mismatch), Oswestry Disability Index (ODI) scores, and visual analog scale (VAS) scores for back and leg pain improved significantly (p < 0.05). For patients in the LS-Only group, there were significant improvements in Cobb angle, ODI score, and VAS scores for back and leg pain. The LS+Apex group had better correction of Cobb angles (56% vs 33%, p = 0.02), SVA (43% vs 5%, p = 0.46), LL (62% vs 13%, p = 0.35), and PI-LL (68% vs 33%, p = 0.32). Despite more LS+Apex patients having major complications (56% vs 13%; p = 0.02) and postoperative leg weakness (31% vs 6%, p = 0.07), there were no intergroup differences in 2-year outcomes.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Long open posterior instrumented fusion with or without multilevel LIF is used to treat a variety of coronal and sagittal adult thoracolumbar deformities. The addition of multilevel LIF to open PSF with L5\u2013S1 interbody support in this small cohort was often used in more severe coronal and\/or lumbopelvic sagittal deformities and offered better correction of major Cobb angles, lumbopelvic parameters, and SVA than posterior-only operations. As these advantages came at the expense of more major complications, more leg weakness, greater blood loss, and longer operative times and hospital stays without an improvement in 2-year outcomes, future investigations should aim to more clearly define deformities that warrant the addition of multilevel LIF to open PSF and L5\u2013S1 interbody fusion.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.8.spine151543","type":"journal-article","created":{"date-parts":[[2016,10,21]],"date-time":"2016-10-21T10:19:49Z","timestamp":1477045189000},"page":"208-219","source":"Crossref","is-referenced-by-count":39,"title":["Utility of multilevel lateral interbody fusion of the thoracolumbar coronal curve apex in adult deformity surgery in combination with open posterior instrumentation and L5\u2013S1 interbody fusion: a case-matched evaluation of 32 patients"],"prefix":"10.3171","volume":"26","author":[{"given":"Alexander A.","family":"Theologis","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory M.","family":"Mundis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, San Diego Center for Spinal Disorders, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacie","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, San Diego Center for Spinal Disorders, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Okonkwo","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Fessler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, NYU Hospital for Joint Diseases;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassel G.","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedat","family":"Deviren","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, San Francisco;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine151543","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"92","DOI":"10.3171\/2011.3.SPINE10425","article-title":"Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study","volume":"15","author":"Acosta FL,","year":"2011","unstructured":"Acosta FL, Liu J, Slimack N, Moller D, Fessler R, Koski T: Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study. 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