Hello, I'm a spine research fellow for the University at Buffalo, a medical student and a PhD candidate. Thank you for allowing me the opportunity to present Influence and Approach on Segmental Lordosis and Spinal Pelvic Correction with Lumbar Interbody Fusion. We wanted to quantify the overall correction by approach and assess how each approach compared to one another. Using the PRISMA guidelines, we conducted a systematic PubMed search based on MeSH terms lumbar interbody fusion, segmental lordosis, and lumbar lordosis. 338 articles were identified. After screening titles and abstracts and assessing for eligibility, 30 studies, which included 2,608 patients, were included for quantitative analysis. First we pooled studies by approach in a first-tier meta-analysis. This resulted in a heterogeneous dataset by approach. In order to compare approaches such that we were comparing apples to apples, we needed to identify the source of heterogeneity. We conducted standard regression analysis but could not identify an individual factor based on demographics, perioperative surgical information, radiographic parameters, or patient reported outcomes. Another cause of heterogeneity is if there were in fact two effects or sub-clusters caused by studies within each approach. We leveraged the large sample size to conduct graphical display of study heterogeneity analysis, or Gaussian analysis. This uses three different machine learning algorithms to identify studies causing secondary effects. By using lumbar lordosis and P-lifts as an example here, Gaussian analysis identifies the greatest effect as being caused by study number two, as represented by the peaks. After removal of studies within each approach, we can compare approaches through a second-level meta-analysis. Our results identify a significant increase in lumbar lordosis and segmental lordosis between pre-op and follow-up in A-lift, lateral, and T-lift approaches. A-lift causes the greatest degree of lumbar lordosis and segmental lordosis. It is two times greater than T-lift on both parameters. As expected, there was no change in pelvic incidence among the three approaches. When comparing between approaches as visualized in the two figures, A-lift re-demonstrates that it causes the greatest degree of lumbar lordosis and segmental lordosis. It is significantly greater compared to T-lift and P-lift, but no significance was felt when comparing with lateral approaches. Lateral approaches induced a greater degree of lumbar lordosis than P-lift, and T-lift induced a greater degree of segmental lordosis compared to P-lift. All approaches provide a significantly greater degree of lumbar lordosis and segmental lordosis at final follow-up except P-lift. Thank you for your attention, and I would like to thank Dr. Jeffrey Mullen and Tim O'Connor for your mentorship and guidance.

segmental lordosis

spinal pelvic correction

lumbar interbody fusion

A-lift

lateral approach