PMID- 38196721
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240111
IS  - 2414-469X (Print)
IS  - 2414-4630 (Electronic)
IS  - 2414-4630 (Linking)
VI  - 9
IP  - 4
DP  - 2023 Dec 25
TI  - Anterior column realignment (ACR) for focal kyphotic spinal deformity using an 
      anterior to psoas approach and anterior longitudinal ligament release.
PG  - 422-433
LID - 10.21037/jss-23-84 [doi]
AB  - BACKGROUND: The anterior-to-psoas (ATP) approach to the lumbar spine has been 
      proposed as an alternative to the transpsoas approach for approaching the disc 
      space without dissecting through the psoas muscle, thus decreasing the risk of 
      injury to the lumbar plexus. There are no prior studies that evaluates the 
      clinical application of anterior longitudinal ligament (ALL) release and anterior 
      column realignment (ACR) using the ATP approach. The objective of this study was 
      to describe and evaluate the safety of ACR using an ATP approach with release of 
      both the ALL and bilateral annulus for correction of a focal kyphotic lumbar 
      deformity. METHODS: A retrospective analysis of fourteen consecutive patients at 
      a single institution between January 2017 and December 2019 of patients 
      undergoing ACR using an ATP approach for lumbar flatback syndrome with focal 
      kyphotic lumbar deformity by a single surgeon was performed. Primary outcome 
      measures were pre- and postoperative radiographic parameters. Secondary outcome 
      measures were perioperative adverse events (AEs), 30-day 
      readmissions/reoperations, discharge disposition, post-operative length of stay 
      (LOS), and radiographic complications. RESULTS: Fourteen consecutive patients 
      (mean age 67.0+/-3.9 years, 8 males, 6 females) with 15 total ACR levels were 
      included in the study. A grade 1 posterior column osteotomy (PCO) with posterior 
      instrumentation was performed at all ACR levels. L2-L3 ACR was performed in nine 
      patients, L3-L4 in four patients, and L4-L5 in two patients. Mean preoperative 
      disk lordotic angle at the ACR level was 5.4 degrees +/-5.9 degrees  of kyphosis. Mean increase in 
      postoperative disk lordotic angle was 24.0 degrees +/-8.5 degrees  at a mean follow-up of 34.0+/-23.4 
      months. CONCLUSIONS: ACR can be performed with a complete ALL release under 
      direct visualization using the ATP approach. This technique can be a safe and 
      effective method for achieving substantial correction of a focal kyphotic 
      deformity within the lumbar spine.
CI  - 2023 Journal of Spine Surgery. All rights reserved.
FAU - Hirase, Takashi
AU  - Hirase T
AD  - Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA.
AD  - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 
      Houston, TX, USA.
FAU - Vemu, Sree M
AU  - Vemu SM
AD  - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 
      Houston, TX, USA.
FAU - Shin, Caleb
AU  - Shin C
AD  - Department of Orthopedic Surgery, Medical City Healthcare, Denton, TX, USA.
FAU - Marco, Rex A W
AU  - Marco RAW
AD  - Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 
      Houston, TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20231009
PL  - China
TA  - J Spine Surg
JT  - Journal of spine surgery (Hong Kong)
JID - 101685460
PMC - PMC10772665
OTO - NOTNLM
OT  - Anterior-to-psoas (ATP)
OT  - anterior column realignment (ACR)
OT  - anterior longitudinal ligament release (ALL release)
OT  - spinal deformity
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://jss.amegroups.com/article/view/10.21037/jss-23-84/coif). RAWM reports 
      that he is a paid presenter and speaker of DePuy, A Johnson & Johnson Company, 
      and received IP royalties from Globus Medical. The other authors have no 
      conflicts of interest to declare.
EDAT- 2024/01/10 06:42
MHDA- 2024/01/10 06:43
PMCR- 2023/12/25
CRDT- 2024/01/10 03:41
PHST- 2023/06/18 00:00 [received]
PHST- 2023/09/08 00:00 [accepted]
PHST- 2024/01/10 06:43 [medline]
PHST- 2024/01/10 06:42 [pubmed]
PHST- 2024/01/10 03:41 [entrez]
PHST- 2023/12/25 00:00 [pmc-release]
AID - jss-09-04-422 [pii]
AID - 10.21037/jss-23-84 [doi]
PST - ppublish
SO  - J Spine Surg. 2023 Dec 25;9(4):422-433. doi: 10.21037/jss-23-84. Epub 2023 Oct 9.