Two-Year Radiological Outcome of Adult Spinal Deformity Treated with Lumbar Pedicle Subtraction Osteotomy or Posterior Lumbar Interbody Fusion: A Propensity Score-Matched Analysis

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OBJECTIVE: The purpose of this retrospective cohort study was to compare the 2-year radiological outcome and revision rates in patients with adult spinal deformity treated with either pedicle subtraction osteotomy (PSO) or posterior lumbar interbody fusion (PLIF), when PLIF was used to improve sagittal balance. METHODS: In 2016, PLIF was introduced at our institution as an alternative method when restoring lumbar lordosis. We analyzed 2 cohorts of patients with adult spinal deformity undergoing either PSO in 2010-2015 or PLIF in 2016-2020, retrospectively. The rate of mechanical failure was analyzed using competing risk analysis. RESULTS: We included 141 patients (111 PSO and 30 PLIF). After propensity score matching, 60 patients undergoing PSO and 30 patients undergoing PLIF were included. Baseline demographics were comparable between groups but radiographic parameters differed significantly on Sacral Slope; 23 ± 13 versus 28 ± 10, and segmental lordosis; 7 ± 14° versus. 14 ± 13° (P-value < 0.05) for PSO and PLIF, respectively. Postoperatively, PSO patients had a larger global lordosis; 54 ± 12 versus 48 ± 14 and segmental lordosis of 33 ± 10 versus 26 ± 10 (P-value < 0.05), than PLIF patients. Competing risk analysis showed a cumulative incidence of revision surgery of 38.3% (95% CI 28-43) versus 16.7 (95% CI 3-30), (P-value < 0.05) for PSO, and PLIF at 2-year follow-up. CONCLUSIONS: A significantly lower revision rate was seen for patients undergoing PLIF compared with PSO at a 2-year follow-up. A satisfactory sagittal correction was obtained for both groups regardless of the procedure. Thus, PLIF could be a viable option in selected cases.

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