{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:27:48Z","timestamp":1792150068583,"version":"4.4.0"},"reference-count":31,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Surgical treatment of adult spinal deformity (ASD) is an effective endeavor that can be accomplished using a variety of surgical strategies. Here, the authors assess and compare radiographic data, complications, and health-related quality-of-life (HRQoL) outcome scores among patients with ASD who underwent a posterior spinal fixation (PSF)\u2013only approach, a posterior approach combined with lateral lumbar interbody fusion (LLIF+PSF), or a posterior approach combined with anterior lumbar interbody fusion (ALIF+PSF).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The medical records of consecutive adults who underwent thoracolumbar fusion for ASD between 2003 and 2013 at a single institution were reviewed. Included were patients who underwent instrumentation from the pelvis to L-1 or above, had a sagittal vertical axis (SVA) of < 10 cm, and underwent a minimum of 2 years\u2019 follow-up. Those who underwent a 3-column osteotomy were excluded. Three groups of patients were compared on the basis of the procedure performed, LLIF+PSF, ALIF+PSF, and PSF only. Perioperative spinal deformity parameters, complications, and HRQoL outcome scores (Oswestry Disability Index [ODI], Scoliosis Research Society 22-question Questionnaire [SRS-22], 36-Item Short Form Health Survey [SF-36], visual analog scale [VAS] for back\/leg pain) from each group were assessed and compared with each other using ANOVA. The minimal clinically important differences used were \u22121.2 (VAS back pain), \u22121.6 (VAS leg pain), \u221215 (ODI), 0.587\/0.375\/0.8\/0.42 (SRS-22 pain\/function\/self-image\/mental health), and 5.2 (SF-36, physical component summary).<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 221 patients (58 LLIF, 91 ALIF, 72 PSF only) met the inclusion criteria. Average deformities consisted of a SVA of < 10 cm, a pelvic incidence\u2013lumbar lordosis (LL) mismatch of > 10\u00b0, a pelvic tilt of > 20\u00b0, a lumbar Cobb angle of > 20\u00b0, and a thoracic Cobb angle of > 15\u00b0. Preoperative SVA, LL, pelvic incidence\u2013LL mismatch, and lumbar and thoracic Cobb angles were similar among the groups. Patients in the PSF-only group had more comorbidities, those in the ALIF+PSF group were, on average, younger and had a lower body mass index than those in the LLIF+PSF group, and patients in the LLIF+PSF group had a significantly higher mean number of interbody fusion levels than those in the ALIF+PSF and PSF-only groups. At final follow-up, all radiographic parameters and the mean numbers of complications were similar among the groups. Patients in the LLIF+PSF group had proximal junctional kyphosis that required revision surgery significantly less often and fewer proximal junctional fractures and vertebral slips. All preoperative HRQoL scores were similar among the groups. After surgery, the LLIF+PSF group had a significantly lower ODI score, higher SRS-22 self-image\/total scores, and greater achievement of the minimal clinically important difference for the SRS-22 pain score.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Satisfactory radiographic outcomes can be achieved similarly and adequately with these 3 surgical approaches for patients with ASD with mild to moderate sagittal deformity. Compared with patients treated with an ALIF+PSF or PSF-only surgical strategy, patients who underwent LLIF+PSF had lower rates of proximal junctional kyphosis and mechanical failure at the upper instrumented vertebra and less back pain, less disability, and better SRS-22 scores.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2017.5.spine161370","type":"journal-article","created":{"date-parts":[[2017,10,31]],"date-time":"2017-10-31T15:12:41Z","timestamp":1509462761000},"page":"40-49","source":"Crossref","is-referenced-by-count":78,"title":["Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance"],"prefix":"10.3171","volume":"28","author":[{"given":"Junseok","family":"Bae","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, South Korea; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A.","family":"Theologis","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Strom","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobby","family":"Tay","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane","family":"Burch","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigurd","family":"Berven","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Neurological Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Neurological Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Neurological Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedat","family":"Deviren","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","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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