PMID- 38337376 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240212 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 13 IP - 3 DP - 2024 Jan 24 TI - Combined Anterior-Posterior vs. Posterior-Only Approach in Adult Spinal Deformity Surgery: Which Strategy Is Superior? LID - 10.3390/jcm13030682 [doi] LID - 682 AB - Introduction: Whether a combined anterior-posterior (AP) approach offers additional benefits over the posterior-only (P) approach in adult spinal deformity (ASD) surgery remains unknown. In a cohort of patients undergoing ASD surgery, we compared the combined AP vs. the P-only approach in: (1) preoperative/perioperative variables, (2) radiographic measurements, and (3) postoperative outcomes. Methods: A single-institution, retrospective cohort study was performed for patients undergoing ASD surgery from 2009 to 2021. Inclusion criteria were >/=5-level fusion, sagittal/coronal deformity, and 2-year follow-up. The primary exposure was the operative approach: a combined AP approach or P alone. Postoperative outcomes included mechanical complications, reoperation, and minimal clinically important difference (MCID), defined as 30% of patient-reported outcome measures (PROMs). Multivariable linear regression was controlled for age, BMI, and previous fusion. Results: Among 238 patients undergoing ASD surgery, 34 (14.3%) patients underwent the AP approach and 204 (85.7%) underwent the P-only approach. The AP group consisted mostly of anterior lumbar interbody fusion (ALIF) at L5/S1 (73.5%) and/or L4/L5 (38.0%). Preoperatively, the AP group had more previous fusions (64.7% vs. 28.9%, p < 0.001), higher pelvic tilt (PT) (29.6 +/- 11.6 degrees vs. 24.6 +/- 11.4 degrees , p = 0.037), higher T1 pelvic angle (T1PA) (31.8 +/- 12.7 degrees vs. 24.0 +/- 13.9 degrees , p = 0.003), less L1-S1 lordosis (-14.7 +/- 28.4 degrees vs. -24.3 +/- 33.4 degrees , p < 0.039), less L4-S1 lordosis (-25.4 +/- 14.7 degrees vs. 31.6 +/- 15.5 degrees , p = 0.042), and higher sagittal vertical axis (SVA) (102.6 +/- 51.9 vs. 66.4 +/- 71.2 mm, p = 0.005). Perioperatively, the AP approach had longer operative time (553.9 +/- 177.4 vs. 397.4 +/- 129.0 min, p < 0.001), more interbodies placed (100% vs. 17.6%, p < 0.001), and longer length of stay (8.4 +/- 10.7 vs. 7.0 +/- 9.6 days, p = 0.026). Radiographically, the AP group had more improvement in T1PA (13.4 +/- 8.7 degrees vs. 9.5 +/- 8.6 degrees , p = 0.005), L1-S1 lordosis (-14.3 +/- 25.6 degrees vs. -3.2 +/- 20.2 degrees , p < 0.001), L4-S1 lordosis (-4.7 +/- 16.4 degrees vs. 3.2 +/- 13.7 degrees , p = 0.008), and SVA (65.3 +/- 44.8 vs. 44.8 +/- 47.7 mm, p = 0.007). These outcomes remained statistically significant in the multivariable analysis controlling for age, BMI, and previous fusion. Postoperatively, no significant differences were found in mechanical complications, reoperations, or MCID of PROMs. Conclusions: Preoperatively, patients undergoing the combined anterior-posterior approach had higher PT, T1PA, and SVA and lower L1-S1 and L4-S1 lordosis than the posterior-only approach. Despite increased operative time and length of stay, the anterior-posterior approach provided greater sagittal correction without any difference in mechanical complications or PROMs. FAU - Younus, Iyan AU - Younus I AD - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA. FAU - Chanbour, Hani AU - Chanbour H AD - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA. FAU - Chen, Jeffrey W AU - Chen JW AD - Department of Neurological Surgery, Baylor College of Medicine, Houston, TX 77030, USA. FAU - Johnson, Graham W AU - Johnson GW AD - School of Medicine, Vanderbilt University, Nashville, TN 37232, USA. FAU - Metcalf, Tyler AU - Metcalf T AD - School of Medicine, Vanderbilt University, Nashville, TN 37232, USA. FAU - Lyons, Alexander T AU - Lyons AT AD - School of Medicine, Vanderbilt University, Nashville, TN 37232, USA. FAU - Jonzzon, Soren AU - Jonzzon S AD - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA. FAU - Liles, Campbell AU - Liles C AD - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA. FAU - Roth, Steven G AU - Roth SG AD - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA. FAU - Abtahi, Amir M AU - Abtahi AM AD - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA. AD - Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA. FAU - Stephens, Byron F AU - Stephens BF AD - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA. AD - Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA. FAU - Zuckerman, Scott L AU - Zuckerman SL AD - Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA. AD - Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA. LA - eng PT - Journal Article DEP - 20240124 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC10856410 OTO - NOTNLM OT - adult spinal deformity OT - anterior-posterior OT - approach OT - outcomes OT - posterior only OT - sagittal malalignment COIS- Zuckerman reports being an unaffiliated neurotrauma consultant for the National Football League. Stephens is a consultant for Nuvasive and receives institutional research support from Nuvasive and Stryker Spine. Abtahi receives institutional research support from Stryker Spine. No other perceived conflicts of interest by any of the listed authors are declared. EDAT- 2024/02/10 10:43 MHDA- 2024/02/10 10:44 PMCR- 2024/01/24 CRDT- 2024/02/10 01:02 PHST- 2023/12/18 00:00 [received] PHST- 2024/01/20 00:00 [revised] PHST- 2024/01/22 00:00 [accepted] PHST- 2024/02/10 10:44 [medline] PHST- 2024/02/10 10:43 [pubmed] PHST- 2024/02/10 01:02 [entrez] PHST- 2024/01/24 00:00 [pmc-release] AID - jcm13030682 [pii] AID - jcm-13-00682 [pii] AID - 10.3390/jcm13030682 [doi] PST - epublish SO - J Clin Med. 2024 Jan 24;13(3):682. doi: 10.3390/jcm13030682.