Impact of Multi-Level Interbody Fusion in the Treatment of Severe Adult Scoliosis (Thoracolumbar Coronal Cobb Angle>50 Degrees)

Presented at SMISS Annual Forum 2016
By Joseph Zavatsky MD
With Behrooz Akbarnia MD, Juan Uribe MD, FACS, Neel Anand MD, Robert Eastlack MD, Michael Wang MD, Praveen Mummaneni MD, Adam Kanter MD, Paul Park MD, International Group , Dean Chou MD, Gregory Mundis MD, Pierce Nunley MD, Stacie Nguyen MPH,

Disclosures: Joseph Zavatsky MD B; Amendia, Biomet, Depuy, Stryker. D; Innovative Surgical Solutions, Safe Wire, Vivex. F; Biomet. Behrooz Akbarnia MD A; Depuy Synthes Spine. B; NuVasive, K2M, Ellipse, Kspine. D; Alphatec Spine, NuVasive, Ellipse, Kspine, Nocimed., Juan Uribe MD, FACS A; Nuvasive. B; Nuvasive. C; Nuvasive. D; Nuvasive. F; Nuvasive, Neel Anand MD None, Robert Eastlack MD None, Michael Wang MD None, Praveen Mummaneni MD B; Globus, Adam Kanter MD None, Paul Park MD B; Biomet, Globus, Medtronic, Nuvasive. F; Globus, International Group A; Biomet, Depuy, Innovasis, K2M, Medtronic, Nuvasive, Stryker., Dean Chou MD None, Gregory Mundis MD A; ISSGF, Nuvasive. B; K2M, Medicrea, Misonix, Nuvasive. C; K2M, Nuvasive. F; Nuvasive., Pierce Nunley MD None, Stacie Nguyen MPH None,

Spine & Scoliosis Specialists, Tampa, FL1; University of Miami, Miami, FL2; University of Michigan, Ann Arbor, MI3; University of California, San Francisco, San Francisco, CA4; University of Pittsburgh Medical Center, Pittsburgh, PA5; University of South Florida, Tampa, FL6; Louisiana Spine Institute, Shreveport, LA7; Scripps Clinic, La Jolla, CA8; San Diego Spine Foundation, San Diego, CA9; Cedars Sinai, Los Angeles, CA10; San Diego Spine Foundation & Scripps Clinic, San Diego, CA11; and International Spine Study Group Foundation, Brighton, CO12


The benefits of surgery in the treatment of severe adult spinal deformity (ASD) have been documented. Specific interbody fusion (IBF) techniques compared to all-posterior technique without IBF have yet to be analyzed. 


To determine if interbody fusion techniques will result in improved radiographic and clinical outcomes compared with all-posterior techniques without interbody fusion. Methods: Patients with ASD having thoracolumbar coronal Cobb angles>50, without primary thoracic curves or 3-column osteotomy, and 2-year follow up were included. Patients were split into 2 groups, IBF vs No IBF. IBF included either percutaneous or open pedicle screws. Open: all-posterior without interbody fusion. Differences in demographic, radiographic, and clinical parameters were analyzed. Subgroup analysis of IBF (ALIF vs TLIF vs LLIF) was performed. 


420 patients met inclusion criteria, of those 165 were identified and 118 had full data for analysis (88 IBF patients; 30 No IBF). IBF were older, had higher BMI, and worse preop ODI (p<0.05). There were differences in pre to post: PT (-3 vs 3, p=0.01), PI-LL (-13.5 vs 5, p<0.001), LL (13.6 vs -3.6, p<0.001), SVA (-36.1 vs 0.6, p=0.002) and ODI (-17.9 vs -7.7, p=0.024) in the IBF vs No IBF. IBF had more staged procedures, blood transfusions, iliac fixation, longer OR time, and LOS (p<0.05). Subgroup analysis revealed LLIF approach had less iliac fixation, EBL, transfusions, and posterior segments fused, while achieving the greatest coronal correction (p<0.05) 


IBF resulted in significant improvements in all spinopelvic parameters including SVA. Subgroup analysis of the IBF Group revealed the LLIF technique had significantly less EBL, transfusions, and posterior segments fused, while achieving the greatest coronal correction compared to ALIF and TLIF.