Anterior Column Realignment in Adult Spinal Deformity: A Case Report and Review of the Literature.
OBJECTIVE
Anterior column realignment (ACR) is a new emerging minimally invasive surgical technique for adult spinal deformity (ASD) that has the potential to provide similar corrective ability to traditional posterior approaches. This article reviews the current literature on the clinical efficacy and safety of ACR and illustrates an additional use of this technique in a case of sagittal imbalance after posterior spinal fusion with segmental instrumentation.


METHODS
We performed a literature search of all published ACR reports using PubMed, including only clinical studies describing the ACR technique and reporting radiographic and/or clinical outcomes.


RESULTS
Thirteen studies were included. Improvement in lumbar lordosis after ACR ranged from 12.7° to 39°, and increases in focal segmental lordosis at each ACR level ranged from 1° to 34°. Good clinical and functional outcomes have consistently been reported after ACR. The complication rate has been comparable to or lower than traditional posterior-based techniques. We also illustrate the use of ACR in a patient with sagittal imbalance after a prior posterior instrumented spinal fusion. ACR in combination with a posterior osteotomy allowed for the induction of lordosis by cantilevering of rods and compression of pedicle screws.


CONCLUSIONS
Radiographic and clinical outcomes after ACR have been promising so far. In addition to primary ASD surgery, ACR can also be effectively used in cases with prior posterior instrumented spinal fusion to correct sagittal imbalance.
['Cheung|Zoe B|ZB|', 'Chen|Daniel H|DH|', 'White|Samuel J W|SJW|', 'Kim|Jun S|JS|', 'Cho|Samuel K|SK|']
D005260:Female D006801:Humans D008141:Lordosis D008875:Middle Aged D059351:Organ Sparing Treatments D058958:Organs at Risk D010027:Osteotomy D013123:Spinal Fusion D013904:Thoracic Vertebrae D016896:Treatment Outcome
Anterior column realignment Adult spinal deformity Minimally invasive Anterior longitudinal ligament release Lateral lumber interbody fusion Sagittal balance