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The article presents a case study of a successful use of minimally invasive anterior column realignment (ACR) for the treatment of flatback deformity and adjacent segment disease. Traditional surgical correction of these conditions involves three column osteotomies, which have high morbidity rates. ACR, on the other hand, involves a lateral approach and release of the anterior longitudinal ligament (ALL), followed by placement of a hyperlordotic interbody cage. The patient in the case study underwent a multistage procedure involving ACR, interbody fusion, 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. The article discusses the advantages of ACR, including its minimally invasive nature and potential benefits for patients with sagittal deformities. The study demonstrates the feasibility and efficacy of minimally invasive ACR in addressing flatback deformity and adjacent segment disease
Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : innovative treatment hospital in London
Published article
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…
Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
J Spine Surg. 2023 Sep 22;9(3):288-293. doi: 10.21037/jss-23-45. Epub 2023 Jul 21.ABSTRACTSurgical 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,
J Spine Surg. 2023 Sep 22;9(3):288-293. doi: 10.21037/jss-23-45. Epub 2023 Jul 21.
ABSTRACT
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.
PMID:37841785 | PMC:PMC10570644 | DOI:10.21037/jss-23-45
The London Spine Unit : innovative treatment hospital in London
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Surgical technique of combined minimally invasive anterior column realignment at L1-L2 with open extension of prior fusion
