Download HealthEast Orthopaedic Spine Seminar Glenn R. Buttermannm MD

XLIF vs ALIF Combined with PSF
Results in a
Community Practice
Glenn R. Buttermann, MD
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Introduction
• XLIF combined with posterior spinal fusion has increased in
popularity for patients with advanced degenerative spinal
conditions as well as selective deformity conditions.
• Prior studies have predominantly been from academic
institutions or by authors who had a financial relationship
to a manufacturer with the potential for bias in reported
outcomes.
• The purpose of this study was to assess outcomes of an
XLIF cohort and compare to a previous prospective cohort of
traditional 2-level anterior/posterior spinal fusion patients
treated for advanced degenerative disc disease.
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Present Study
• Indications for XLIF patient (n=41) were primary surgical fusion
for lumbar DDD, adjacent segment degenerative condition, or
as part of a hybrid procedure for spinal deformity.
• Prospective study: Visual Analog Scale for back pain and leg
pain, pain drawing, ODI.
• Follow-up periods were at six-month to one year intervals with
minimum two-year follow-up.
• Comparative anterior/posterior spinal fusion cohort (n=50)
had similar prospective outcomes evaluation.
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XLIF/PSF vs ASF/PSF
Age (mean +/- SD)
Female (%)
Smokers (%)
Work Comp/Lit (%)
Osteoporosis (%)
EBL (ml, mean +/- SD)
XLIF/PSF
59.1
±
18.8
78
10
5
24
283
±
188
ASF/PSF
44.0
±
11.5
68
50
48
36
498
±
297
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Major XLIF Dx
• Primary Degenerative condition
Example: L45 post-lami DDD
Preop
Postop
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Major XLIF Dx
• Adjacent segment degenerative condition
Example: L23 Adj DDD/stenosis/retrolisthesis
Preop
Postop
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Major XLIF Dx: Adult Deformity
Example: AIS lumbar motion segment sparing method
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Major XLIF Dx: Adult Deformity
• Degenerative scoliosis, spondylolisthesis &
stenosis
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Low Back & Leg Pain Outcomes
Fig. 1, BACK PAIN
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XLIF/PSF (n=41)
ASF/PSF (n=50)
6
4
2
0
PRE-OP
7-12 MONTH
1-2 YEARS
Fig. 2, LEG PAIN
2-4 YEARS
FOLLOW-UP PERIOD
VAS
VAS
8
10
XLIF/PSF (n=41)
8
ASF/PSF (n=50)
6
4
2
0
PRE-OP
7-12 MONTH
1-2 YEARS
2-4 YEARS
FOLLOW-UP PERIOD
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Pain Drawing & ODI Outcomes
20
18
16
14
12
10
8
6
4
2
0
XLIF/PSF (n=41)
ASF/PSF (n=50)
PRE-OP
7-12 MONTH
1-2 YEARS
2-4 YEARS
Fig. 4, OSWESTRY DISABILITY
FOLLOW-UP PERIOD
XLIF/PSF (n=41)
80
ASF/PSF (n=50)
70
Degree of Disability
PAIN AREA
Fig. 3, PAIN DRAWING
60
50
40
30
20
10
0
PRE-OP
7-12 MONTH
1-2 YEARS
2-4 YEARS
FOLLOW-UP PERIOD
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Results
• Most common indication for XLIF was adjacent level
degenerative condition s/p prior lumbar fusion (29 of 41
patients).
• Both XLIF/PSF and ASF/PSF groups had significantly improved
outcomes at all follow-up periods.
• There was no significant difference in outcomes between
XLIF/PSF and ASF/PSF groups, however demographics differ
between cohorts.
• Patients in both XLIF and AP fusion groups who had interbody
device subsidence were found to have osteoporosis.
• Transient neurological deficits were most common at L4-5 in
the XLIF cohort.
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Discussion
• The outcomes of XLIF combined with PSF were
statistically similar to ASF/PSF outcomes in patients
undergoing primary fusion.
• The XLIF approach avoids
potential
complications related to
revision ASF
approach in patients
who have adjacent
level conditions
yet obtains similar clinical
success.
• Patients with osteoporosis require
individualized treatment:
additional
Subsidence in osteoporotic pt.
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