Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 May 9:6:100068.
doi: 10.1016/j.xnsj.2021.100068. eCollection 2021 Jun.

Short-segment minimally disruptive anterior column release for focal sagittal deformity correction of the thoracolumbar spine

Antoine G Tohmeh  1 , Sahir S Jabbouri  2 , Alexandre Vesselle  2 , Kelli M Howell  3
Affiliations
Case Reports

Short-segment minimally disruptive anterior column release for focal sagittal deformity correction of the thoracolumbar spine

Antoine G Tohmeh et al. N Am Spine Soc J. .

Abstract

Background: Sagittal malalignment is associated with poor quality of life. Correction of lumbar lordosis through anterior column release (ACR) has been shown to improve overall sagittal alignment, however typically in combination with long posterior constructs and associated morbidity. The technical feasibility and radiographic outcomes of short-segment anterior or lateral minimally invasive surgery (MIS) ACR techniques in moderate to severe lumbar sagittal deformity were evaluated.

Methods: Consecutive patients treated with short-segment MIS ACR techniques for moderate to severe lumbar sagittal deformity correction were retrospectively analyzed from a prospectively collected database. Clinical outcomes included perioperative measures of invasiveness, including operative time, blood loss, complications, and average length of stay. Radiographic outcomes included measurement of preoperative, immediate postoperative, and long-term follow-up radiographic parameters including coronal Cobb angle, lumbar lordosis (LL), pelvic incidence (PI), PI-LL mismatch, pelvic tilt (PT), T1 pelvic angle (TPA), T1 spino-pelvic inclination (T1SPI), proximal junctional angle (PJA), and sagittal vertical axis (SVA).

Results: The cohort included 34 patients (mean age 63) who were treated at an average 2.5 interbody levels (range 1-4) through a lateral or anterior approach (LLIF or ALIF). Of 89 total interbody levels treated, 63 (71%) were ACR levels. Posterior fixation was across an average of 3.2 levels (range 1-5). Mean total operative time and blood loss were 362 minutes and 621 mL. Surgical complications occurred in 2 (5.9%). Average hospital stay was 5.5 days (including staging). At last follow-up (average 25.4 months; range 0.5-7 years), all patients (100%) demonstrated successful achievement of one or more alignment goal, with significant improvements in coronal Cobb, LL, PI-LL mismatch, PT, and TPA. No patient was revised for PJK.

Conclusions: These data show that short-segment MIS ACR correction of moderate to severe lumbar sagittal deformity is feasible and effective at achieving overall alignment goals with low procedural morbidity and risk of proximal junctional issues.

Keywords: Anterior column release (ACR); Anterior lumbar interbody fusion (ALIF); Lateral lumbar interbody fusion (LLIF); Minimally invasive surgery (MIS); Proximal junctional kyphosis (PJK); Upper instrumented vertebra (UIV).

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Preoperative (left) and last (7-yr) postoperative (right) standing lateral radiographs of a 55-year-old male who underwent L2-L5 LLIF ACR with staged grade II osteotomies and open pedicle fixation posteriorly. Short-segment approach in this patient resulted in improved lumbar lordosis (+25.0° overall, and +8.2° across L4-S1) and corrected overall standing alignment. LL = lumbar lordosis; PI = pelvic incidence; PI-LL = pelvic incidence - lumbar lordosis mismatch; PT = pelvic tilt; SVA = sagittal vertical axis.
Fig. 2
Fig. 2
Preoperative (left) and last (2-yr) postoperative (right) standing lateral radiographs of a 68-year-old female who underwent L2-S1 anterior column realignment via L2-L4 LLIF ACR and L4-S1 ALIF ACR, with percutaneous posterior fixation L2-Ileum. Short-segment approach in this patient resulted in improved and harmonious lumbar lordosis and corrected overall standing alignment. LL = lumbar lordosis; PI = pelvic incidence; PI-LL = pelvic incidence - lumbar lordosis mismatch; PT = pelvic tilt; T1SPI = T1 spino-pelvic inclination.
See this image and copyright information in PMC

References

    1. Ozgur B.M., Aryan H.E., Pimenta L., Taylor W.R. Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6:435–443. - PubMed
    1. Anand N., Baron E.M., Khandehroo B. Limitations and ceiling effects with circumferential minimally invasive correction techniques for adult scoliosis: Analysis of radiological outcomes over a 7-year experience. Neurosurg Focus. 2014;36(5):E14. - PubMed
    1. Yson S.C., Sembrano J.N., Santos E.R., Luna J.T., P.o.l.l.y.D.W. Jr Does prone repositioning before posterior fixation produce greater lordosis in lateral lumbar interbody fusion (LLIF)? J Spinal Disord Tech. 2014;27(7):364–369. - PubMed
    1. Isaacs R.E., Hyde J., Goodrich J.A., Rodgers W.B., Phillips F.M. A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine. 2010;35(26 Suppl):S322–S330. - PubMed
    1. Rodgers W.B., Cox C.S., Gerber E.J. Early complications of extreme lateral interbody fusion in the obese. J Spinal Disord Tech. 2010;23(6):393–397. - PubMed

Publication types