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Anterior column realignment following lateral interbody fusion for sagittal deformity correction

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Degenerative and iatrogenic diseases may lead to loss of lordosis or even kyphotic thoracolumbar deformity and sagittal misalignment. Traditional surgery with three-column osteotomies is associated with important neurologic risks and postoperative morbidity. In a novel technique, the lateral transpsoas interbody fusion (LTIF) is complemented with the sacrifice of the anterior longitudinal ligament and anterior portion of the annulus followed by the insertion of a hyperlordotic interbody cage. This is a less invasive lateral technique named anterior column realignment (ACR) and aims to correct sagittal misalignment in adult spinal deformity (ASD), with or without the addition of minor posterior osteotomies. In this article, we provide an account of the evolution to the ACR technique, the literature, and the Brazilian experience in the treatment of adult spinal deformity with this novel advanced application of LTIF. In the presence of ASD, the risk-to-benefit ratio of a surgical correction must be evaluated. Less invasive surgical strategies can be alternatives to treat the deformity and provide better quality of life to the patient. ACR is an advanced application of lateral transpsoas approach, up to date has shown to be reliable and effective when used for ASD, and may minimize complications and morbidity from traditional surgical procedures. Long-term follow-up and comparative studies are needed to evaluate real benefit.

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Conflict of interest

Dr. Pimenta is a paid consultant, owns stock options, and receives royalties from NuVasive, LLC. Dr. Amaral and Dr. Jensen are paid consultants from NuVasive, LLC. The other authors have nothing to disclose. 

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Authors and Affiliations

  1. Instituto de Patologia da Coluna, Rua Vergueiro, 1421, suite 305, São Paulo, SP, 04101-000, Brazil

    Luiz Pimenta, Fernanda Fortti, Leonardo Oliveira, Luis Marchi, Rubens Jensen, Etevaldo Coutinho & Rodrigo Amaral

  2. Department of Neurosurgery, UCSD, San Diego, CA, USA

    Luiz Pimenta

Authors
  1. Luiz Pimenta
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  2. Fernanda Fortti
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  3. Leonardo Oliveira
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  4. Luis Marchi
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  5. Rubens Jensen
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  6. Etevaldo Coutinho
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  7. Rodrigo Amaral
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Correspondence to Luis Marchi.

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Pimenta, L., Fortti, F., Oliveira, L. et al. Anterior column realignment following lateral interbody fusion for sagittal deformity correction. Eur J Orthop Surg Traumatol 25 (Suppl 1), 29–33 (2015). https://doi.org/10.1007/s00590-015-1642-1

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  • DOI: https://doi.org/10.1007/s00590-015-1642-1

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