• Jonathan N Sembrano, Sharon C Yson, Ryan D Horazdovsky, Edward Rainier G Santos, and David W Polly.
• Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
• Int J Spine Surg. 2015 Jan 1;9:16.

BackgroundLateral approach to lumbar fusion has been gaining popularity in recent years. With increasing awareness of the significance of sagittal balance restoration in spinal surgery, it is important to investigate the potential of this relatively new approach in correcting sagittal deformities in comparison to conventional approaches. The aim of this study was to evaluate sagittal contour changes seen in lateral lumbar interbody fusion and compare them with radiographic changes in traditional approaches to lumbar fusion.MethodsLumbar fusion procedures from January 2008 to December 2009 were reviewed. Four approaches were compared: anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF), transforaminal interbody fusion (TLIF) and posterior spinal fusion (PSF). Standing pre-operative and 6-week post-operative radiographs were measured in terms of operative level, suprajacent and subjacent level, and regional lumbar lordosis (L1-S1) as well as operative level anterior (ADH) and posterior disc heights (PDH). T-test was used to analyze differences between and within different approaches (α=0.05).ResultsA total of 147 patients underwent lumbar fusion at 212 levels. Mean operative level segmental lordosis change after each procedure is as follows: ALIF 3.8 ± 6.6° (p < 0.01); LLIF 3.2 ± 3.6° (p<0.01); TLIF 1.9 ± 3.9° (p<0.01); and PSF 0.7 ± 2.9° (p =0.13). Overall lumbar lordosis change after each procedure is as follows: ALIF 4.2 ± 5.8° (p < 0.01); LLIF 2.5 ± 4.1° (p<0.01); TLIF 2.1 ± 6.0 (p = 0.02); PSF -0.5 ± 6.2° (p = 0.66). There were no significant changes in the supradjcent and subjacent level lordosis in all approaches except in ALIF where a significant decrease in supradjecent level lordosis was seen. Mean ADH and PDH significantly increased for all approaches except in PSF where PDH decreased post-operatively.ConclusionLLIF has the ability to improve sagittal contour as well as other interbody approaches and is superior to posterioronly approach in disc height restoration. However, ALIF provides the greatest amount of segmental and overall lumbar lordosis correction.Level Of EvidenceThis is a Level III study.Clinical RelevanceRegional lordosis correction may be effectively achieved with LLIF. This approach is a good addition to a surgeon's armamentarium in maintenance or restoration of normal lumbar sagittal alignment.

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