• Andrew K Chan, Shailen G Sampath, Praveen V Mummaneni, Paul Park, Juan S Uribe, Jay D Turner, Vivian P Le, Robert K Eastlack, Richard G Fessler, Khoi D Than, Kai-Ming Fu, Michael Y Wang, Adam S Kanter, David O Okonkwo, Pierce D Nunley, Neel Anand, Gregory M Mundis, Peter G Passias, Shay Bess, Christopher I Shaffrey, Dean Chou, and International Spine Study Group.
• Department of Neurological Surgery, Columbia University, New York, NY, USA.
• Spine. 2024 Nov 7.

Study DesignRetrospective analysis of prospective multicenter adult spinal deformity (ASD) database.ObjectiveTo determine the prevalence and prognosis of postoperative coronal malalignment following LLIF for ASD with Qiu type A coronal alignment.Summary Of Background DataQiu Type A coronal alignment is defined as coronal vertical axis (CVA) <30mm.1 There is concern that circumferential minimally invasive surgery (cMIS) with lateral lumbar interbody fusion (LLIF) is associated with postoperative coronal malalignment in ASD with preoperative Qiu type A patients.MethodsQui type A patients undergoing cMIS with LLIF for ASD were included, with ASD defined with at least: maximum CC≥20°, SVA>5 cm, PI-LL≥10°, or PT>20°. Two year (2Y) clinical outcomes were compared for type A with 2Y CVA≥30 mm (MAL) versus <30 mm (ALIGN) and were adjusted for factors reaching P<0.05 on univariate comparisons (age, BMI, and ODI).Results43 patients met inclusion criteria, of which 12 (27.9%) developed coronal malalignment and 31 (72.1%) remained coronally aligned at 2Y. At baseline, MAL were older (73.0 vs. 69.0, P=0.045), had a lower BMI (26.09 vs. 29.45, P=0.047), and were less disabled (ODI 42.83 vs. 51.69, P=0.016). Otherwise, the groups were well-matched for baseline characteristics. At 2Y, MAL had a greater 2Y SVA (mean 54.08 vs 19.00 mm, P=0.01). Clinically, MAL was associated with inferior 2Y SF-36 PCS (34.78 vs. 37.42, adj P=0.043) and 2Y SRS-22r function/activity domain (3.03 vs. 3.36, adj P=0.040), but otherwise similar in other patient-reported-outcome-metrics (adj P>0.05 for all). 2Y complications were similar between groups, including for reoperations and major and minor complications (adj P>0.05 for all).ConclusionsIn Qui type A patients undergoing cMIS with LLIF for ASD, 27.9% develop coronal malalignment, which was associated with worse SF-36 PCS and SRS-22r function/activity. Despite radiographic malalignment, malalignment was not associated with higher 2-year complication rates including reoperations.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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