scholarly journals Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment

2020 ◽  
Vol 10 (2_suppl) ◽  
pp. 101S-110S
Author(s):  
Jakub Godzik ◽  
Bernardo de Andrada Pereira ◽  
Courtney Hemphill ◽  
Corey T. Walker ◽  
Joshua T. Wewel ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Anterior Column ◽  
Future Research ◽  
Invasive Technique ◽  
Review Of The Literature ◽  
Surgical Options ◽  
Segmental Lordosis

Study Design: Review of the literature. Objectives: Anterior column realignment (ACR) is a powerful but relatively new minimally invasive technique for deformity correction. The purpose of this study is to provide a literature review of the ACR surgical technique, reported outcomes, and future directions. Methods: A review of the literature was performed regarding the ACR technique. A review of patients at our single center who underwent ACR was performed, with illustrative cases selected to demonstrate basic and nuanced aspects of the technique. Results: Clinical and cadaveric studies report increases in segmental lordosis in the lumbar spine by 73%, approximately 10° to 33°, depending on the degree of posterior osteotomy and lordosis of the hyperlordosis interbody spacer. These corrections have been found to be associated with a similar risk profile compared with traditional surgical options, including a 30% to 43% risk of proximal junctional kyphosis in early studies. Conclusions: ACR represents a powerful technique in the minimally invasive spinal surgeon’s toolbox for treatment of complex adult spinal deformity. The technique is capable of significant sagittal plane correction; however, future research is necessary to ascertain the safety profile and long-term durability of ACR.

A Critical Analysis of Sagittal Plane Deformity Correction with Minimally Invasive Adult Spinal Deformity Surgery: A Two-Year Follow-Up Study

2015 ◽  
Vol 15 (10) ◽  
pp. S126-S127
Author(s):  
International Spine Study Group ◽  
Gregory M. Mundis ◽  
Jay D. Turner ◽  
Vedat Deviren ◽  
Juan S. Uribe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Deformity ◽  
Critical Analysis ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Follow Up Study ◽  
Spinal Deformity Surgery ◽  
Plane Deformity

Retrospective Multicenter Assessment of Rod Fracture After Anterior Column Realignment in Minimally Invasive Adult Spinal Deformity Correction

2019 ◽  
Vol 130 ◽  
pp. e400-e405 ◽  
Author(s):  
Jakub Godzik ◽  
Jack M. Haglin ◽  
Nima Alan ◽  
Randall J. Hlubek ◽  
Corey T. Walker ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Anterior Column ◽  
Rod Fracture

Usefulness of anterior column release for segmental lordosis restoration in degenerative lumbar kyphosis

2021 ◽  
pp. 1-7
Author(s):  
Jin-Sung Park ◽  
Chong-Suh Lee ◽  
Youn-Taek Choi ◽  
Se-Jun Park
Keyword(s):  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Anterior Column ◽  
Sacral Slope ◽  
High Morbidity ◽  
Global Sagittal Alignment ◽  
The Mean ◽  
Lumbar Kyphosis ◽  
Segmental Lordosis

OBJECTIVE Three-column osteotomies (3COs) for surgical correction of lumbar kyphosis show a strong correction capacity, but this procedure carries high morbidity rates. The anterior column release (ACR) technique was developed as a less invasive procedure. In this study the authors aimed to evaluate sagittal alignment restoration using ACR and to determine factors that affect the degree of correction. METHODS This study included 36 patients (68 cases) who underwent ACR of more than one level for adult spinal deformity. Parameters for regional sagittal alignment included segmental lordosis (SL). The parameters for global sagittal alignment included pelvic incidence, lumbar lordosis, sacral slope, pelvic tilt, and sagittal vertical axis (SVA). In addition, the interdiscal height (IDH) and difference of interdiscal angle (DIDA) were measured to evaluate the stiffness of the vertebra segment. The changes in SL were evaluated after ACR and the change of global sagittal alignment was also determined. Factors such as the location of the ACR level, IDH, DIDA, cage height, and additional posterior column osteotomy (PCO) were analyzed for correlation with the degree of SL correction. RESULTS Thirty-six patients were included in this study. A total of 68 levels were operated with the ACR (8 levels at L2–3, 27 levels at L3–4, and 33 levels at L4–5). ACR was performed for 1 level in 10 patients, 2 levels in 20, and 3 levels in 6 patients (mean 1.9 ± 0.7 levels per patient). Mean follow-up duration was 27.1 ± 4.2 months. The mean SL of the total segment was 0.4° ± 7.2° preoperatively and increased by 15.3° ± 5.5° at the last follow-up (p < 0.001); thus, the mean increase of SL was 14.9° ± 8.1° per one ACR. Global sagittal alignment was also improved following SL restoration with SVA from 101.9 mm to 31.4 mm. The degree of SL correction was correlated with the location of ACR level (p = 0.041) and was not correlated with IDH, DIDA, cage height and additional PCO. CONCLUSIONS This study demonstrated that the mean correction angle of SL was 14.9 per one ACR. The degree of disc space collapse and stiffness of segment did not affect the degree of correction by ACR.

Adult Spinal Deformity Correction with Multi-level Anterior Column Releases

2016 ◽  
Vol 29 (4) ◽  
pp. 141-149 ◽  
Author(s):  
Gokhan Demirkiran ◽  
Alexander A. Theologis ◽  
Murat Pekmezci ◽  
Christopher Ames ◽  
Vedat Deviren
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Anterior Column ◽  
Multi Level

Anterior Longitudinal Ligament Release From the Minimally Invasive Lateral Retroperitoneal Transpsoas Approach: Technical Note

2016 ◽  
Vol 12 (3) ◽  
pp. 214-221 ◽  
Author(s):  
Joshua M Beckman ◽  
Nicola Marengo ◽  
Gisela Murray ◽  
Konrad Bach ◽  
Juan S Uribe
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Vascular Complications ◽  
Deformity Correction ◽  
Anterior Longitudinal Ligament ◽  
Global Improvement ◽  
Transpsoas Approach ◽  
Indirect Decompression

Abstract BACKGROUND The technique for minimally invasive anterior longitudinal ligament release is a major advancement in lateral access surgery. This method provides hypermobility of lumbar segments to allow for aggressive lordosis restoration while maintaining the benefits of indirect decompression and minimally invasive access. OBJECTIVE To provide video demonstration of the lateral retroperitoneal transpsoas approach with anterior longitudinal ligament sectioning. METHODS A detailed surgical technique of the minimally invasive anterior column release is described and illustrated in an elderly patient with adult spinal deformity and low back pain (visual analog scale, 8 of 10) refractory to conservative measures. The 3-foot standing radiographs demonstrated a lumbar lordosis of 54.4°, pelvic incidence of 63.7°, and pelvic tilt of 17.5°. Computed tomography and magnetic resonance imaging showed generalized lumbar spondylosis and degenerative disc changes from L2 to L5. RESULTS The patient underwent a multilevel minimally invasive deformity correction with an anterior longitudinal ligament release at the L3/L4 level through the lateral retroperitoneal transpsoas approach. Lumbar lordosis increased from 54.4° to 77° with a global improvement in sagittal vertical axis from 4.37 cm to 0 cm. Total blood loss was less than 25 mL, and there were no major neurological or vascular complications. CONCLUSION The anterior longitudinal ligament release using the minimally invasive lateral approach allows for deformity correction without the morbidity and blood loss encountered by traditional open posterior approaches. However, the risk of major vascular/visceral complication warrants only experts in minimally invasive lateral surgery to attempt this technique.

Sign in / Sign up

Export Citation Format

Share Document