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Surgical technique of combined minimally invasive anterior column realignment at L1-L2 with open extension of prior fusion.

Publication ,  Journal Article
Bergin, SM; Dibble, CF; Lee, HJ; Abd-El-Barr, MM; Shaffrey, CI; Than, KD
Published in: J Spine Surg
September 22, 2023

Surgical correction of fixed kyphotic deformity or severe sagittal imbalance traditionally involves three column osteotomies, which are associated with high morbidity rates. Anterior column realignment (ACR) has emerged as a minimally invasive alternative for restoring segmental lordosis. This technique involves a lateral approach and release of the anterior longitudinal ligament (ALL), followed by placement of a hyperlordotic interbody cage. In this study, we present a successful case of minimally invasive ACR for the treatment of flatback deformity and adjacent segment disease in a patient with prior L2-S1 fusion. Imaging revealed a flatback deformity, sagittal vertical axis elevation, and spinopelvic disharmony. The patient underwent a multistage procedure involving a lateral retropleural approach for ACR and interbody fusion, followed by open posterior instrumented fusion and vertebroplasties. Postoperatively, the patient experienced significant pain relief and improvement in lumbar lordosis, pelvic tilt, and pelvic incidence-lumbar lordosis mismatch. ACR combined with posterior release allows for manipulation of all three spinal columns, leading to spine reconstruction and improved spinopelvic harmony. We discuss the advantages of ACR, including its minimally invasive nature and potential benefits for patients with sagittal deformities. The presented surgical technique demonstrates the feasibility and efficacy of minimally invasive ACR in addressing flatback deformity and adjacent segment disease.

Duke Scholars

Published In

J Spine Surg

DOI

ISSN

2414-469X

Publication Date

September 22, 2023

Volume

9

Issue

3

Start / End Page

288 / 293

Location

China
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Bergin, S. M., Dibble, C. F., Lee, H. J., Abd-El-Barr, M. M., Shaffrey, C. I., & Than, K. D. (2023). Surgical technique of combined minimally invasive anterior column realignment at L1-L2 with open extension of prior fusion. J Spine Surg, 9(3), 288–293. https://doi.org/10.21037/jss-23-45
Bergin, Stephen M., Christopher F. Dibble, Ho Jin Lee, Muhammad M. Abd-El-Barr, Christopher I. Shaffrey, and Khoi D. Than. “Surgical technique of combined minimally invasive anterior column realignment at L1-L2 with open extension of prior fusion.J Spine Surg 9, no. 3 (September 22, 2023): 288–93. https://doi.org/10.21037/jss-23-45.
Bergin SM, Dibble CF, Lee HJ, Abd-El-Barr MM, Shaffrey CI, Than KD. Surgical technique of combined minimally invasive anterior column realignment at L1-L2 with open extension of prior fusion. J Spine Surg. 2023 Sep 22;9(3):288–93.
Bergin, Stephen M., et al. “Surgical technique of combined minimally invasive anterior column realignment at L1-L2 with open extension of prior fusion.J Spine Surg, vol. 9, no. 3, Sept. 2023, pp. 288–93. Pubmed, doi:10.21037/jss-23-45.
Bergin SM, Dibble CF, Lee HJ, Abd-El-Barr MM, Shaffrey CI, Than KD. Surgical technique of combined minimally invasive anterior column realignment at L1-L2 with open extension of prior fusion. J Spine Surg. 2023 Sep 22;9(3):288–293.

Published In

J Spine Surg

DOI

ISSN

2414-469X

Publication Date

September 22, 2023

Volume

9

Issue

3

Start / End Page

288 / 293

Location

China