ORIGINAL ARTICLE The role of minimally invasive lateral lumbar interbody fusion in sagittal balance correction and spinal deformity Giuseppe Costanzo • Carmine Zoccali • Philip Maykowski • Christina M. Walter • Jesse Skoch • Ali A. Baaj Received: 29 August 2014 / Revised: 3 September 2014 / Accepted: 3 September 2014 / Published online: 13 September 2014 Ó Springer-Verlag Berlin Heidelberg 2014 Abstract Purpose The recent proliferation of minimally invasive lateral lumbar interbody fusion (LLIF) techniques has drawn attention to potential for these techniques to control or correct sagittal misalignment in adult spinal deformity. We systemically reviewed published studies related to LLIF use in adult spinal deformity treatment with emphasis on radiographic assessment of sagittal balance. Methods A literature review was conducted to examine studies focusing on sagittal balance restoration in adult degenerative scoliosis with the LLIF approach. Results Fourteen publications, 12 retrospective and 2 prospective, reported data regarding lumbar lordosis cor- rection (1,266 levels in 476 patients) but only two mea- sured global sagittal alignment. Conclusion LLIF appears to be especially effective when the lumbar lordosis and sagittal balance correction goals are less than 10° and 5 cm, respectively. However, the review demonstrated a lack of consistent reporting on sagittal balance restoration with the MIS LLIF techniques. Keywords Lateral interbody fusion Á LLIF Á Degenerative lumbar scoliosis Á Intervertebral disk degeneration Á Sagittal balance Á Lumbar lordosis correction Introduction In recent years, sagittal balance has become a much debated topic. This is due in large part to its influence on patient satisfaction and clinical outcomes, as shown in various biomechanical and clinical studies on degenerative and idiopathic scoliosis [1, 2]. In the same way, the development and diffusion of the new minimally invasive anterior techniques, such as the LLIF techniques [3], reveal their ability to control and cor- rect sagittal misalignment. Lateral approaches (such as XLIF and DLIF) provide reduced risks related to the anterior direct approaches as anesthetic complications, visceral damage, large vessels bleeding and sexual dysfunctions and should permit an early patient mobilization [4–8]. Nevertheless, the ability to correct global misalignment is not clear. Traditional techniques, used to correct sagittal imbal- ance, include the shortening of posterior column as the Smith-Petersen or the pedicle subtraction osteotomies and the anterior–posterior spine-shortening procedure, but they are associated with high intraoperative risk for bleeding and neurological damage [9–12]. Today minimally invasive LLIF techniques are recog- nized as able to decompress neural structures by indirect distraction [13]; however, no clear data are present in the literature about its ability to correct sagittal alignment. The aim of this work is to review the pertinent literature as it pertains to the role of the LLIF techniques in correcting sagittal balance. G. Costanzo Department of Orthopaedic Surgery, Polo Pontino, University of Rome Sapienza, Via Bertero 49, 00156 Rome, Italy C. Zoccali (&) Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IFO-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy e-mail: carminezoccali@libero.it P. Maykowski Á C. M. Walter Á J. Skoch Á A. A. Baaj Division of Neurosurgery, University of Arizona College of Medicine, 1501 N Campbell Avenue, 85724 Tucson, AZ, United States 123 Eur Spine J (2014) 23 (Suppl 6):S699–S704 DOI 10.1007/s00586-014-3561-y