Anterior Column Realignment: Analysis of Neurological Risk and Radiographic Outcomes

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S19-S19
Author(s):  
Rajiv Saigal ◽  
Behrooz A Akbarnia ◽  
Robert K Eastlack ◽  
Ali Bagheri ◽  
Stacie Tran ◽  
...  
Keyword(s):  
Anterior Column ◽  
Radiographic Outcomes ◽  
Neurological Risk

Commentary: Anterior Column Realignment: Analysis of Neurological Risk and Radiographic Outcomes

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. E357-E358
Author(s):  
Christina Huang Wright ◽  
Manish K Kasliwal
Keyword(s):  
Anterior Column ◽  
Radiographic Outcomes ◽  
Neurological Risk

Anterior Column Realignment: Analysis of Neurological Risk and Radiographic Outcomes

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. E347-E354 ◽  
Author(s):  
Rajiv Saigal ◽  
Behrooz A Akbarnia ◽  
Robert K Eastlack ◽  
Ali Bagheri ◽  
Stacie Tran ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Anterior Column ◽  
Motor Deficit ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Sagittal Vertical Axis ◽  
Pelvic Inclination ◽  
Radiographic Outcomes ◽  
Neurological Risk

Abstract BACKGROUND Anterior column realignment (ACR) is a less invasive alternative to 3-column osteotomy for the correction of sagittal imbalance. We hypothesized that ACR would correct sagittal imbalance with an acceptable neurological risk. OBJECTIVE To assess long-term neurological and radiographic outcomes after ACR. METHODS Patients ≥18 yr who underwent ACR from 2005 to 2013 were eligible. Standing scoliosis radiographs were studied at preoperation, postoperation (≤6 wk), and at minimum 2 yr of follow-up. Clinical/radiographic data were collected through a retrospective chart review, with thoracic 1 spino-pelvic inclination (T1SPi) used as the angular surrogate for sagittal vertical axis. RESULTS A total of 26 patients had complete data, with a mean follow-up of 2.8 yr (1.8-7.4). Preoperative, sagittal parameters were lumbar lordosis (LL) of −16.1°, pelvic incidence (PI)-LL of 41.7°, T1SPi of 3.6°, and pelvis tilt (PT) of 32.4°. LL improved by 30.6° (P < .001) postoperation. Mean changes in PT (−8.3), sacral slope (8.9), T1SPi (−4.9), and PI-LL (−33.5) were all significant. The motion segment angle improved by 26.6°, from 5.2° to −21.4° (P < .001). Neurological complications occurred in 32% patients postoperation (n = 8; 1 patient with both sensory and motor). New thigh numbness/paresthesia developed in 3 (13%) patients postoperation; only 1 (4%) persisted at latest follow-up. A total of 6 (24%) patients developed a new lower extremity motor deficit postoperation, with 4 (8%) having persistent new weakness at last follow-up. Out of 8 patients with preoperative motor deficit, half saw improvement postoperation and 75% improved by last follow-up. CONCLUSION There was net motor improvement, with 24% of patients improving and 16% having persistent new weakness at latest follow-up; 60% were unchanged. Radiographic results demonstrate that ACR is a useful tool to treat severe sagittal plane deformity.

scholarly journals The comprehensive anatomical spinal osteotomy and anterior column realignment classification

2018 ◽  
Vol 29 (5) ◽  
pp. 565-575 ◽  
Author(s):  
Juan S. Uribe ◽  
Frank Schwab ◽  
Gregory M. Mundis ◽  
David S. Xu ◽  
Jacob Januszewski ◽  
...  
Keyword(s):  
Interobserver Reliability ◽  
Spinous Process ◽  
Pedicle Subtraction Osteotomy ◽  
Anterior Column ◽  
Disc Space ◽  
Interspinous Ligament ◽  
Radiographic Outcomes ◽  
Grade 5 ◽  
Grade 3 ◽  
Additional Resection

OBJECTIVESpinal osteotomies and anterior column realignment (ACR) are procedures that allow preservation or restoration of spine lordosis. Variations of these techniques enable different degrees of segmental, regional, and global sagittal realignment. The authors propose a comprehensive anatomical classification system for ACR and its variants based on the level of technical complexity and invasiveness. This serves as a common language and platform to standardize clinical and radiographic outcomes for the utilization of ACR.METHODSThe proposed classification is based on 6 anatomical grades of ACR, including anterior longitudinal ligament (ALL) release, with varying degrees of posterior column release or osteotomies. Additionally, a surgical approach (anterior, lateral, or posterior) was added. Reliability of the classification was evaluated by an analysis of 16 clinical cases, rated twice by 14 different spine surgeons, and calculation of Fleiss kappa coefficients.RESULTSThe 6 grades of ACR are as follows: grade A, ALL release with hyperlordotic cage, intact posterior elements; grade 1 (ACR + Schwab grade 1), additional resection of the inferior facet and joint capsule; grade 2 (ACR + Schwab grade 2), additional resection of both superior and inferior facets, interspinous ligament, ligamentum flavum, lamina, and spinous process; grade 3 (ACR + Schwab grade 3), additional adjacent-level 3-column osteotomy including pedicle subtraction osteotomy; grade 4 (ACR + Schwab grade 4), 2-level distal 3-column osteotomy including pedicle subtraction osteotomy and disc space resection; and grade 5 (ACR + Schwab grade 5), complete or partial removal of a vertebral body and both adjacent discs with or without posterior element resection. Intraobserver and interobserver reliability were 97% and 98%, respectively, across the 14-reviewer cohort.CONCLUSIONSThe proposed anatomical realignment classification provides a consistent description of the various posterior and anterior column release/osteotomies. This reliability study confirmed that the classification is consistent and reproducible across a diverse group of spine surgeons.

Anterior Column Realignment: A Detailed Analysis of Neurologic Risk and Radiographic Outcomes

2016 ◽  
Vol 16 (10) ◽  
pp. S191
Author(s):  
Rajiv Saigal ◽  
Gregory M. Mundis ◽  
Stacie Nguyen ◽  
Ali Bagheri ◽  
Ramin Bagheri ◽  
...  
Keyword(s):  
Detailed Analysis ◽  
Anterior Column ◽  
Radiographic Outcomes

Radiographic outcomes of anterior column realignment for adult sagittal plane deformity: a multicenter analysis

2015 ◽  
Vol 24 (S3) ◽  
pp. 427-432 ◽  
Author(s):  
Jay D. Turner ◽  
Behrooz A. Akbarnia ◽  
Robert K. Eastlack ◽  
Ramin Bagheri ◽  
Stacie Nguyen ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Anterior Column ◽  
Radiographic Outcomes ◽  
Multicenter Analysis ◽  
Plane Deformity

Radiographic Outcomes of Ring External Fixation for Malunion and Nonunion

2013 ◽  
Vol 22 (04) ◽  
pp. 316-320 ◽  
Author(s):  
Robert K. Lark ◽  
John S. Lewis Jr. ◽  
Tyler Steven Watters ◽  
Robert D. Fitch
Keyword(s):  
External Fixation ◽  
Radiographic Outcomes

Long-Term Outcomes after Colton Type I and II Fractures of the Olecranon

2019 ◽  
Vol 13 (1) ◽  
pp. 208-216
Author(s):  
Thord von Schewelov ◽  
Fredrik Hertervig ◽  
Per-Olof Josefsson ◽  
Jack Besjakov ◽  
Ralph Hasserius
Keyword(s):  
Joint Space ◽  
Type I ◽  
Type Ii ◽  
Men And Women ◽  
Radiographic Outcomes ◽  
Fracture Event ◽  
Comminuted Fractures ◽  
Fracture Types ◽  
Transverse Fractures ◽  
Olecranon Fractures

Background: It is unclear if the outcomes differ in different subtypes of olecranon fractures. Objective: Evaluate the outcomes of different Colton types of olecranon fractures, and if outcomes differ in dominant and non-dominant arms and in men and women. Methods: We evaluated primary journals and radiographs in 40 men and 55 women with isolated olecranon fractures and classified fractures according to Colton. Mean 19 years after fracture event, we re-examined subjective, clinical and radiographic outcomes in the former patients, using the uninjured arms as controls. Results: 89% of patients with Colton type I fractures reported at follow-up no subjective differences between the elbows, 84% with type II oblique/transverse fractures and 84% with type II comminuted fractures (p=0.91). The uninjured to former fractured arm differences in elbow range of motion and strength were no different in the 3 fracture types, the proportions of individuals with radiographic elbow degenerative changes were greater in type II than in type I factures (p<0.001), and there were no differences between the proportions of individuals with reduced joint space in the 3 groups (p=0.40). The outcomes were no different if the fractures had occurred in the dominant or non-dominant arms (p=0.43), or in men or women (p=0.43). Conclusion: There were no different outcomes after Colton type I, type II oblique/transverse or type II comminuted fractures, no different outcomes between fractures in dominant or non-dominant arms and no different outcomes in men and women.

Sign in / Sign up

Export Citation Format

Share Document