Anterior Column Realignment has Similar Results to Pedicle Subtraction Osteotomy in Treating Adults with Sagittal Plane Deformity

International Spine Study Group

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective Anterior column realignment (ACR) is a minimally invasive surgical technique used for the correction of adult sagittal plane deformity. ACR is performed via a minimally invasive lateral transpsoas approach with anterior longitudinal ligament release and hyperlordotic cage placement. The objective of this study was to compare radiographic outcomes and complications in patients treated by ACR or Pedicle subtraction osteotomy (PSO). Methods Patients who underwent ACR were matched with patients from a retrospective PSO dataset, by pelvic incidence, lumbar lordosis, and thoracic kyphosis. Inclusion criteria included pelvic incidence and lumbar lordosis mismatch > 10°, pelvic tilt > 25°, and/or C7 sagittal vertical axis >5 cm, and minimum 1-year follow-up. Results All (n = 17) patients who underwent ACR underwent second-stage open posterior instrumented fusion. There were no differences in baseline demographic or radiographic parameters. Both groups were found to have significant improvement from preoperative to final follow-up for lumbar lordosis, T1 spinopelvic inclination, and T1 pelvic angle. Pelvic tilt did not improve with PSO (31° to 28°) at final follow-up but did improve in ACR group (34° to 25°). No differences were identified at 3-month or final follow-up for lumbar lordosis (51° vs. 47°), pelvic tilt (25° vs. 28°), and T1 pelvic angle (23° vs. 24°). The group undergoing PSO achieved greater T1 spinopelvic inclination correction (8° vs. 1.9°). Patients who underwent ACR had significantly less estimated blood loss than patients who underwent PSO (1.6 vs. 3.6 L, respectively), but no difference in the overall major complication rates was found (35.3% vs. 41.2%, respectively). Conclusions ACR achieved similar radiographic results as PSO in a matched cohort with significantly less estimated blood loss and similar overall complication rate.

Original languageEnglish (US)
Pages (from-to)249-256
Number of pages8
JournalWorld Neurosurgery
Volume105
DOIs
StatePublished - Sep 1 2017

Fingerprint

Osteotomy
Lordosis
Longitudinal Ligaments
Kyphosis
Incidence
Thorax
Demography

Keywords

  • Adult spinal deformity
  • Anterior column realignment
  • Pedicle subtraction osteotomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Anterior Column Realignment has Similar Results to Pedicle Subtraction Osteotomy in Treating Adults with Sagittal Plane Deformity. / International Spine Study Group.

In: World Neurosurgery, Vol. 105, 01.09.2017, p. 249-256.

Research output: Contribution to journalArticle

@article{a4bb315f5e894a1eb4ba85723ceb539e,
title = "Anterior Column Realignment has Similar Results to Pedicle Subtraction Osteotomy in Treating Adults with Sagittal Plane Deformity",
abstract = "Objective Anterior column realignment (ACR) is a minimally invasive surgical technique used for the correction of adult sagittal plane deformity. ACR is performed via a minimally invasive lateral transpsoas approach with anterior longitudinal ligament release and hyperlordotic cage placement. The objective of this study was to compare radiographic outcomes and complications in patients treated by ACR or Pedicle subtraction osteotomy (PSO). Methods Patients who underwent ACR were matched with patients from a retrospective PSO dataset, by pelvic incidence, lumbar lordosis, and thoracic kyphosis. Inclusion criteria included pelvic incidence and lumbar lordosis mismatch > 10°, pelvic tilt > 25°, and/or C7 sagittal vertical axis >5 cm, and minimum 1-year follow-up. Results All (n = 17) patients who underwent ACR underwent second-stage open posterior instrumented fusion. There were no differences in baseline demographic or radiographic parameters. Both groups were found to have significant improvement from preoperative to final follow-up for lumbar lordosis, T1 spinopelvic inclination, and T1 pelvic angle. Pelvic tilt did not improve with PSO (31° to 28°) at final follow-up but did improve in ACR group (34° to 25°). No differences were identified at 3-month or final follow-up for lumbar lordosis (51° vs. 47°), pelvic tilt (25° vs. 28°), and T1 pelvic angle (23° vs. 24°). The group undergoing PSO achieved greater T1 spinopelvic inclination correction (8° vs. 1.9°). Patients who underwent ACR had significantly less estimated blood loss than patients who underwent PSO (1.6 vs. 3.6 L, respectively), but no difference in the overall major complication rates was found (35.3{\%} vs. 41.2{\%}, respectively). Conclusions ACR achieved similar radiographic results as PSO in a matched cohort with significantly less estimated blood loss and similar overall complication rate.",
keywords = "Adult spinal deformity, Anterior column realignment, Pedicle subtraction osteotomy",
author = "{International Spine Study Group} and Mundis, {Gregory M.} and Turner, {Jay D.} and Nima Kabirian and Jeff Pawelek and Eastlack, {Robert K.} and Juan Uribe and Klineberg, {Eric Otto} and Shay Bess and Chris Ames and Vedat Deviren and Stacie Nguyen and Virginie Lafage and Akbarnia, {Behrooz A.}",
year = "2017",
month = "9",
day = "1",
doi = "10.1016/j.wneu.2017.05.122",
language = "English (US)",
volume = "105",
pages = "249--256",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Anterior Column Realignment has Similar Results to Pedicle Subtraction Osteotomy in Treating Adults with Sagittal Plane Deformity

AU - International Spine Study Group

AU - Mundis, Gregory M.

AU - Turner, Jay D.

AU - Kabirian, Nima

AU - Pawelek, Jeff

AU - Eastlack, Robert K.

AU - Uribe, Juan

AU - Klineberg, Eric Otto

AU - Bess, Shay

AU - Ames, Chris

AU - Deviren, Vedat

AU - Nguyen, Stacie

AU - Lafage, Virginie

AU - Akbarnia, Behrooz A.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Objective Anterior column realignment (ACR) is a minimally invasive surgical technique used for the correction of adult sagittal plane deformity. ACR is performed via a minimally invasive lateral transpsoas approach with anterior longitudinal ligament release and hyperlordotic cage placement. The objective of this study was to compare radiographic outcomes and complications in patients treated by ACR or Pedicle subtraction osteotomy (PSO). Methods Patients who underwent ACR were matched with patients from a retrospective PSO dataset, by pelvic incidence, lumbar lordosis, and thoracic kyphosis. Inclusion criteria included pelvic incidence and lumbar lordosis mismatch > 10°, pelvic tilt > 25°, and/or C7 sagittal vertical axis >5 cm, and minimum 1-year follow-up. Results All (n = 17) patients who underwent ACR underwent second-stage open posterior instrumented fusion. There were no differences in baseline demographic or radiographic parameters. Both groups were found to have significant improvement from preoperative to final follow-up for lumbar lordosis, T1 spinopelvic inclination, and T1 pelvic angle. Pelvic tilt did not improve with PSO (31° to 28°) at final follow-up but did improve in ACR group (34° to 25°). No differences were identified at 3-month or final follow-up for lumbar lordosis (51° vs. 47°), pelvic tilt (25° vs. 28°), and T1 pelvic angle (23° vs. 24°). The group undergoing PSO achieved greater T1 spinopelvic inclination correction (8° vs. 1.9°). Patients who underwent ACR had significantly less estimated blood loss than patients who underwent PSO (1.6 vs. 3.6 L, respectively), but no difference in the overall major complication rates was found (35.3% vs. 41.2%, respectively). Conclusions ACR achieved similar radiographic results as PSO in a matched cohort with significantly less estimated blood loss and similar overall complication rate.

AB - Objective Anterior column realignment (ACR) is a minimally invasive surgical technique used for the correction of adult sagittal plane deformity. ACR is performed via a minimally invasive lateral transpsoas approach with anterior longitudinal ligament release and hyperlordotic cage placement. The objective of this study was to compare radiographic outcomes and complications in patients treated by ACR or Pedicle subtraction osteotomy (PSO). Methods Patients who underwent ACR were matched with patients from a retrospective PSO dataset, by pelvic incidence, lumbar lordosis, and thoracic kyphosis. Inclusion criteria included pelvic incidence and lumbar lordosis mismatch > 10°, pelvic tilt > 25°, and/or C7 sagittal vertical axis >5 cm, and minimum 1-year follow-up. Results All (n = 17) patients who underwent ACR underwent second-stage open posterior instrumented fusion. There were no differences in baseline demographic or radiographic parameters. Both groups were found to have significant improvement from preoperative to final follow-up for lumbar lordosis, T1 spinopelvic inclination, and T1 pelvic angle. Pelvic tilt did not improve with PSO (31° to 28°) at final follow-up but did improve in ACR group (34° to 25°). No differences were identified at 3-month or final follow-up for lumbar lordosis (51° vs. 47°), pelvic tilt (25° vs. 28°), and T1 pelvic angle (23° vs. 24°). The group undergoing PSO achieved greater T1 spinopelvic inclination correction (8° vs. 1.9°). Patients who underwent ACR had significantly less estimated blood loss than patients who underwent PSO (1.6 vs. 3.6 L, respectively), but no difference in the overall major complication rates was found (35.3% vs. 41.2%, respectively). Conclusions ACR achieved similar radiographic results as PSO in a matched cohort with significantly less estimated blood loss and similar overall complication rate.

KW - Adult spinal deformity

KW - Anterior column realignment

KW - Pedicle subtraction osteotomy

UR - http://www.scopus.com/inward/record.url?scp=85021103055&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021103055&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2017.05.122

DO - 10.1016/j.wneu.2017.05.122

M3 - Article

C2 - 28559074

AN - SCOPUS:85021103055

VL - 105

SP - 249

EP - 256

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -