Minimally Invasive Anterior Column Reconstruction for Sagittal Plane Deformities

2013 ◽  
pp. 273-286
Author(s):  
Armen Deukmedjian ◽  
Juan S. Uribe
Keyword(s):  
Minimally Invasive ◽  
Sagittal Plane ◽  
Anterior Column ◽  
Anterior Column Reconstruction

Anterior Column Reconstruction vs Pedicle Subtraction Osteotomy for Severe Sagittal Plane Deformity: Early Clinical and Radiographic Outcomes Using a Hyperlordotic Expandable Lateral Interbody Device

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Lara Walsh Massie ◽  
Mohamed Macki ◽  
Hesham M Zakaria ◽  
Michelle Gilmore ◽  
Azam Basheer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Sagittal Plane ◽  
Pedicle Subtraction Osteotomy ◽  
Anterior Column ◽  
Significant Difference ◽  
Sagittal Parameters ◽  
Plane Deformity ◽  
Lateral Interbody ◽  
Anterior Column Reconstruction

Abstract INTRODUCTION Anterior Column Reconstruction (ACR) is an increasingly utilized minimally invasive alternative to Pedicle Subtraction Osteotomy (PSO) for correction of sagittal plane deformity in patients with an available unfused lumbar disc. METHODS Fifteen consecutive patients with significant sagittal plane imbalance (SVA > 10 cm or PI-LL mismatch/planned correction > 30?) after prior lumbar fusion were analyzed. Patients underwent either an ACR (N = 11) using an expandable, hyperlordotic lateral interbody device if possible via an unfused disc space, or PSO (n = 4). RESULTS There were no significant differences between the baseline sagittal parameters in the ACR and PSO groups: PI: 59.09? vs 57.67?, P = .88; LL 18.36? vs 28.50?, P = .38; PT: 32.72? vs 37.00?, P = .64; SVA: 12.72 cm vs 11.95 cm P = .77; segmental angulation 2.72? vs 2.75?, P = .99. ACR produced significant improvements in sagittal parameters after surgery compared with preoperative parameters: LL 55.27?, P = .0001; Pi-LL Mismatch 3.45?, P = .0001; PT 22.45?, P = .0254; SVA 4.621 cm P = .0019; segmental angle 25.09?, P < .0001. PSO also produced significant segmental lordosis (29.00?, P = .0032), which was not significantly different from the correction achieved by ACR (25.09? vs 29.00?, P = .47). In ACR, an average of 24.31? of lordosis was achieved at the index level, with an average cage expansion of 24.08?. There was no significant difference in the number of levels fused posteriorly between the ACR and PSO groups (7 vs 8.75 levels, P = .175) or length of surgery (375.25 min vs 370.5 min, P = .47). However, there was significantly less blood loss in the ACR group (311.15 mL vs 962.5 mL, P = .0004) and shorter length of stay (7.41 d vs 11 d, P = .034). CONCLUSION ACR with a hyperlordotic, expandable lateral interbody cage for significant sagittal deformity produced an equivalent degree of sagittal correction to PSO with significantly less blood loss and shorter hospital length of stay.

Endoscopy-assisted Approaches for Anterior Column Reconstruction after Pedicle Screw Fixation of Acute Traumatic Thoracic and Lumbar Fractures

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS445-ONS453 ◽  
Author(s):  
Florian Ringel ◽  
Michael Stoffel ◽  
Carsten Stüer ◽  
Silke Totzek ◽  
Bernhard Meyer
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Anterior Column ◽  
Open Approach ◽  
Surgical Data ◽  
Lumbar Fractures ◽  
Anterior Column Reconstruction

Abstract Objective: Surgical treatment of thoracic and lumbar vertebral body fractures combines instrumentation to stabilize the fracture and an anterior reconstruction to promote fusion of the fractured spine. The aim of the present study was to show that minimally invasive thoracoscopic or endoscopy-assisted approaches to the thoracic and lumbar spine are feasible for anterior column reconstruction. Methods: This prospective, single-center study included 83 consecutive patients harboring 100 acute thoracic and lumbar vertebral fractures. Patients' neurological status; preoperative, postoperative, and follow-up radiographic data; and surgical data were obtained. Results: Fractures ranged from T5 to L5. All fractures underwent posterior pedicle screw fixation followed by a thoracoscopic or endoscopy-assisted anterior approach for anterior column reconstruction to promote fusion. Ventral graft position was correct in 45 patients and acceptable in 37 patients; one patient required a surgical repositioning. Initial correction of kyphosis was 9 degrees; during follow-up (23 ± 11 mo), the mean loss of correction was 6 degrees. In 84 minimally invasive approaches, five conversions to an open approach were necessary. Complications included one case of L1 nerve root injury, two cases of transient neurological worsening, one case of posterior wound infection, and one case of pleural empyema. Conclusion: The minimally invasive endoscopic approach for anterior column reconstruction is a feasible strategy in the treatment of unstable thoracic and lumbar fractures. Fracture type and the material of the anterior graft can affect long-term maintenance of correction.

scholarly journals Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment

2020 ◽  
Vol 10 (2_suppl) ◽  
pp. 101S-110S
Author(s):  
Jakub Godzik ◽  
Bernardo de Andrada Pereira ◽  
Courtney Hemphill ◽  
Corey T. Walker ◽  
Joshua T. Wewel ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Anterior Column ◽  
Future Research ◽  
Invasive Technique ◽  
Review Of The Literature ◽  
Surgical Options ◽  
Segmental Lordosis

Study Design: Review of the literature. Objectives: Anterior column realignment (ACR) is a powerful but relatively new minimally invasive technique for deformity correction. The purpose of this study is to provide a literature review of the ACR surgical technique, reported outcomes, and future directions. Methods: A review of the literature was performed regarding the ACR technique. A review of patients at our single center who underwent ACR was performed, with illustrative cases selected to demonstrate basic and nuanced aspects of the technique. Results: Clinical and cadaveric studies report increases in segmental lordosis in the lumbar spine by 73%, approximately 10° to 33°, depending on the degree of posterior osteotomy and lordosis of the hyperlordosis interbody spacer. These corrections have been found to be associated with a similar risk profile compared with traditional surgical options, including a 30% to 43% risk of proximal junctional kyphosis in early studies. Conclusions: ACR represents a powerful technique in the minimally invasive spinal surgeon’s toolbox for treatment of complex adult spinal deformity. The technique is capable of significant sagittal plane correction; however, future research is necessary to ascertain the safety profile and long-term durability of ACR.

Minimally Invasive Thoracic Corpectomy: 3-Dimensional Operative Video of a Posterolateral Approach to Decompression and Anterior Column Reconstruction

2013 ◽  
Vol 73 (2) ◽  
pp. ons141-ons141
Author(s):  
Zachary A. Smith ◽  
Albert P. Wong ◽  
Tarek Y. El Ahmadieh ◽  
Salah G. Aoun ◽  
Raqeeb Haque ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anterior Column ◽  
Posterolateral Approach ◽  
3 Dimensional ◽  
Anterior Column Reconstruction
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