The Use Of Lateral Interbody Fusion With Concomitant Smith-peterson Osteotomies To Improve Sagittal Balance And Increase Lumbar Lordosis

Presented at SMISS Annual Forum 2014
By Anthony Kwon MD
With Michael Pettus MD,

Disclosures: Anthony Kwon MD B; Nuvasive, F; Globus Michael Pettus MD None,

Introduction:
The harmony between lumbar lordosis and pelvic incidence has been shown to be critical in achieving not only good global sagittal balance but satisfactory clinical outcomes as well. Many of the techniques to achieve sagittal balance are technically challenging and come at great physiologic cost to the patient as well.

Aims/Objectives:
To quantify the amount of lordosis able to be gained by using a combination of both lateral interbody fusion with posterior instrumentation and concomitant Smith-Peterson osteotomies Methods: 21 patients underwent single or two level lateral inter body fusions followed by posterior fusion, instrumentation and Smith-Peterson osteotomies. AP and lateral radiographs were taken pre and post operatively and measured to asses improvement of lumbar lordosis at each of the levels. Operative time as well as EBL were measured as well.

Results:
18 patients underwent single level and 3 patients underwent 2 level combined lateral interbody fusion with posterior SPO and instrumentation. The average number of levels fused was 2.7. An average of 26.2 degrees of improvement of lumbar lordosis per level was achieved. Average improvement of SVA was 18.1 cm. Average EBL per case was 360 cc. Average operative time 188 mins. There were no complications related to the procedure. One patient required a transfusion of packed red blood cells in the post-operative period.

Conclusions:
The combination of lateral interbody fusion with SPOs is an effective method to create lumbar lordosis and achieve significant correction without the blood loss and morbidity of significant posterior based osteotomies.