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

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Abstract

Purpose

Anterior column reconstruction (ACR) is a minimally invasive technique for the treatment of sagittal plane deformity. ACR uses a lateral transpsoas approach with ALL release and the application of an interbody device to achieve correction. Here, we present 1-year radiographic results from a multicenter study of adult spinal deformity (ASD) patients.

Methods

A multicenter database was queried from 2005 to 2013 for ASD patients treated with ACR. Demographics, surgical data, and radiographic measurements were collected and retrospectively analyzed. Radiographic time points included preoperative (pre-op), postoperative (post-op; first visit prior to 3 months), and last follow-up (last FU; minimum of 1 year). Sagittal radiographic measurements included regional lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), T1 spinopelvic inclination (T1SPi), and segmental lordosis (disc angle).

Results

Mean patient age was 67.4 years (range 46.5–80.0) and 11 patients (32.4 %) were male. Twenty patients (58.8 %) had previous lumbar surgery. All patients had a minimal of one-level ACR with ALL release (mean 1.7; range 1–4). Mean number of lateral interbody fusion (LLIF) levels without ALL release per patient was 0.7 (range 0–3). Thirty-three patients (97.1 %) received supplemental posterior fixation and 1 patient (2.9 %) had lateral fixation only. In 26 patients (76.5 %), supplemental posterior fixation was performed using an open approach, and 7 patients (20.6 %) were treated with percutaneous placement. Mean of number of levels fused was 7.1 (range 2–16). There was a significant improvement in LL (p < 0.001), PI-LL mismatch (p < 0.001), and PT (p = 0.03) from pre-op to post-op, and pre-op to last FU. There was no change in T1SPi, SS, or PI. Segmental lordosis improved at ACR levels from mean of −2.2° pre-op to −16.0° post-op (p < 0.01) and −16.3° at last FU (p < 0.001). The addition of posterior column osteotomy increased the change in segmental lordosis with ACR by 72.7 % (p < 0.001). LLIF without ALL release led to significant improvement in segmental lordosis from pre-op (−2.4°) to post-op (−7.1°; p < 0.01) but not from pre-op to last FU (−5.7°; p = 0.06).

Conclusion

ACR successfully restores lumbar lordosis in ASD patients with sagittal imbalance. ACR results in greater segmental correction than is achieved with LLIF alone. Supplementing with posterior osteotomies allows for even greater correction. The ability to achieve the desired radiographic goals is expected to improve as technical nuances are refined and patient selection is optimized.

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References

  1. Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, Boachie-Adjei O, Burton DC, Akbarnia BA, Mundis GM, Ames CP, Kebaish K, Hart RA, Farcy JP, Lafage V (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine 38:E803–E812. doi:10.1097/BRS.0b013e318292b7b9

    Article  PubMed  Google Scholar 

  2. Pellise F, Vila-Casademunt A, Ferrer M, Domingo-Sabat M, Bago J, Perez-Grueso FJ, Alanay A, Mannion AF, Acaroglu E (2015) Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 24:3–11. doi:10.1007/s00586-014-3542-1

    Article  PubMed  Google Scholar 

  3. Smith JS, Singh M, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, Protopsaltis T, Ibrahimi D, Scheer JK, Mundis G Jr, Gupta MC, Hostin R, Deviren V, Kebaish K, Hart R, Burton DC, Bess S, Ames CP (2014) Surgical treatment of pathological loss of lumbar lordosis (flatback) in patients with normal sagittal vertical axis achieves similar clinical improvement as surgical treatment of elevated sagittal vertical axis: clinical article. J Neurosurg Spine 21:160–170. doi:10.3171/2014.3.SPINE13580

    Article  PubMed  Google Scholar 

  4. Smith JS, Klineberg E, Schwab F, Shaffrey CI, Moal B, Ames CP, Hostin R, Fu KM, Burton D, Akbarnia B, Gupta M, Hart R, Bess S, Lafage V (2013) Change in classification grade by the SRS-Schwab Adult Spinal Deformity Classification predicts impact on health-related quality of life measures: prospective analysis of operative and nonoperative treatment. Spine 38:1663–1671. doi:10.1097/BRS.0b013e31829ec563

    Article  PubMed  Google Scholar 

  5. Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:E599–E606. doi:10.1097/BRS.0b013e3181aad219

    Article  PubMed  Google Scholar 

  6. Auerbach JD, Lenke LG, Bridwell KH, Sehn JK, Milby AH, Bumpass D, Crawford CH 3rd, O’Shaughnessy BA, Buchowski JM, Chang MS, Zebala LP, Sides BA (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine 37:1198–1210. doi:10.1097/BRS.0b013e31824fffde

    Article  PubMed  Google Scholar 

  7. Kim SS, Cho BC, Kim JH, Lim DJ, Park JY, Lee BJ, Suk SI (2012) Complications of posterior vertebral resection for spinal deformity. Asian Spine J 6:257–265. doi:10.4184/asj.2012.6.4.257

    Article  PubMed Central  PubMed  Google Scholar 

  8. Kim YJ, Bridwell KH, Lenke LG, Cheh G, Baldus C (2007) Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine 32:2189–2197. doi:10.1097/BRS.0b013e31814b8371

    Article  PubMed  Google Scholar 

  9. O’Neill KR, Lenke LG, Bridwell KH, Hyun SJ, Neuman B, Dorward I, Koester L (2014) Clinical and radiographic outcomes after 3-column osteotomies with 5-year follow-up. Spine 39:424–432. doi:10.1097/BRS.0000000000000156

    Article  PubMed  Google Scholar 

  10. Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH (2002) Posterior vertebral column resection for severe spinal deformities. Spine 27:2374–2382. doi:10.1097/01.BRS.0000032026.72156.1D

    Article  PubMed  Google Scholar 

  11. Akbarnia BA, Mundis GM Jr, Moazzaz P, Kabirian N, Bagheri R, Eastlack RK, Pawelek JB (2014) Anterior column realignment (ACR) for focal kyphotic spinal deformity using a lateral transpsoas approach and ALL release. J Spinal Disord Tech 27:29–39. doi:10.1097/BSD.0b013e318287bdc1

    Article  PubMed  Google Scholar 

  12. Deukmedjian AR, Dakwar E, Ahmadian A, Smith DA, Uribe JS (2012) Early outcomes of minimally invasive anterior longitudinal ligament release for correction of sagittal imbalance in patients with adult spinal deformity. Sci World J 2012:789698. doi:10.1100/2012/789698

    Article  Google Scholar 

  13. Marchi L, Oliveira L, Amaral R, Castro C, Coutinho T, Coutinho E, Pimenta L (2012) Anterior elongation as a minimally invasive alternative for sagittal imbalance-a case series. HSS J 8:122–127. doi:10.1007/s11420-011-9226-z

    Article  PubMed Central  PubMed  Google Scholar 

  14. Uribe JS, Smith DA, Dakwar E, Baaj AA, Mundis GM, Turner AW, Cornwall GB, Akbarnia BA (2012) Lordosis restoration after anterior longitudinal ligament release and placement of lateral hyperlordotic interbody cages during the minimally invasive lateral transpsoas approach: a radiographic study in cadavers. J Neurosurg Spine 17:476–485. doi:10.3171/2012.8.SPINE111121

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by NuVasive, Inc.

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Correspondence to Gregory M. Mundis Jr..

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Turner, J.D., Akbarnia, B.A., Eastlack, R.K. et al. Radiographic outcomes of anterior column realignment for adult sagittal plane deformity: a multicenter analysis. Eur Spine J 24 (Suppl 3), 427–432 (2015). https://doi.org/10.1007/s00586-015-3842-0

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  • DOI: https://doi.org/10.1007/s00586-015-3842-0

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