- Interbody technique (ALIF, TLIF, LLIF, NO-LIF) did not significantly affect LSF correction or postoperative coronal malalignment.
- Among TLIFs, banana cages yielded greater magnitude and percentage LSF correction than bullet cages, independent on multivariable analysis.
- Findings support selecting interbody approach at lumbosacral junction to optimise fractional curve correction in adult spinal deformity surgery.
World Neurosurg. 2026 Nov 5:125493. doi: 10.1016/j.wneu.2026.125493. Online ahead of print.
ABSTRACT
OBJECTIVES: In patients undergoing adult spinal deformity (ASD) surgery, we compared the lumbosacral fractional curve (LSF)correction between:1) ALIF, TLIF, LLIF, and NO-LIF, and 2) among TLIFs, banana vs. bullet cages.
METHODS: Patients undergoing ASD surgery (2009-24) were included. The cohort was divided into four groups: ALIF, TLIF, LLIFs, and NO-LIF. TLIFs were subdivided into banana vs. bullet cages. Preoperative/postoperative LSF correction was assessed as: 1) magnitude of change, and 2) postoperative values. Coronal malalignment (CM) was defined as coronal vertical axis ≥3cm. Multivariable analyses controlled for age, sex, total instrumented levels, and preoperative LSF.
RESULTS: Of 221 patients (mean age:60±18 years, 31% males), mean preoperative/postoperative LSF were 13±10° and 7±6°. Interbody approaches were: ALIFs-20%, TLIFs-21%, LLIFs-5%, and NO-LIF-54%. Preoperative/postoperative CM rates were 28% and 20%. Comparison between interbodies: LSF correction did not differ significantly across groups (p=0.687), nor did postoperative LSF after adjusting for preoperative values. Postoperative CM rates were also similar (p=0.814). Banana vs. Bullet Cage: Among 47 patients undergoing TLIFs (53% banana, 47% bullet), banana cages were associated with greater magnitude (9±8° vs. 2±7°, p=0.002;β=4.31, 95%CI:0.60-8.02, p=0.024) and percentage correction (47% vs. 5%, p=0.010;β=36.68, 95%CI:3.05-70.32, p=0.033). Postoperative LSF (9±7° vs. 10±7°, p=0.773) and CM (28% vs. 9%, p=0.144) were similar.
CONCLUSION: In ASD surgery, interbody technique did not influence correction of LSF or postoperative CM; however, among TLIFs, banana cages were independently associated with improved LSF correction. These findings may help guide interbody selection at the lumbosacral junction when aiming to optimize fractional curve correction.
PMID:42988157 | DOI:10.1016/j.wneu.2026.125493
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