The comprehensive anatomical spinal osteotomy and anterior column realignment classification

Uribe, Juan S.; Schwab, Frank J.; Mundis, Gregory M.; Xu, David S.; Januszewski, Jacob; Kanter, Adam S.; Okonkwo, David O.; Hu, Serena S.; Deviren, Vedat; Eastlack, Robert K.; Berjano, Pedro; Mummaneni, Praveen V.

doi:10.3171/2018.4.spine171206

Cited by 57 publications

(47 citation statements)

References 41 publications

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“…11 Grade II consists of removal of both inferior and superior facets of an articulation at the index level as well as the flavum ligament; other posterior elements of the vertebra, including the lamina and the spinous processes, can also be removed. 12…”

Section: Discussionmentioning

confidence: 99%

“…Severe osteopenia and osteoporosis, with a T-score less than −2.0 at the femoral neck, should also contraindicate lateral ACR, because intervertebral subsidence represents an important concern and can cause failure of the treatment. 12…”

Section: Target/patient Selectionmentioning

confidence: 99%

“…Posterior construct supplementation with pedicle screws and rods should follow ACR, and posterior osteotomy can be used to increase lordosis gain if needed (Table 1). 12…”

Section: Surgical Techniquementioning

confidence: 99%

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Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment

Godzik

Pereira

Hemphill

et al. 2020

Global Spine Journal

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Target/patient Selectionmentioning

confidence: 99%

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Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment

Godzik

Pereira

Hemphill

et al. 2020

Global Spine Journal

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“…As a means of addressing sagittal malalignment through a minimally invasive lateral approach, the anterior column release has been introduced in which the anterior longitudinal ligament is released at an open disc space level. 89 In addition, Wang and Bordon have described an MIS PSO technique in which the procedure is performed using MIS techniques except for the spinal levels immediately adjacent to the PSO. 90 Patient selection for MIS ASD treatment remains a challenge.…”

Section: Current Applications and Algorithmsmentioning

confidence: 99%

Treatment of adult thoracolumbar spinal deformity: past, present, and future

Smith

Shaffrey

Ames

et al. 2019

Journal of Neurosurgery: Spine

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Care of the patient with adult spinal deformity (ASD) has evolved from being primarily supportive to now having the ability to directly treat and correct the spinal pathology. The focus of this narrative literature review is to briefly summarize the history of ASD treatment, discuss the current state of the art of ASD care with focus on surgical treatment and current challenges, and conclude with a discussion of potential developments related to ASD surgery.In the past, care for ASD was primarily based on supportive measures, including braces and assistive devices, with few options for surgical treatments that were often deemed high risk and reserved for rare situations. Advances in anesthetic and critical care, surgical techniques, and instrumentation now enable almost routine surgery for many patients with ASD. Despite the advances, there are many remaining challenges currently impacting the care of ASD patients, including increasing numbers of elderly patients with greater comorbidities, high complication and reoperation rates, and high procedure cost without clearly demonstrated cost-effectiveness based on standard criteria. In addition, there remains considerable variability across multiple aspects of ASD surgery. For example, there is currently very limited ability to provide preoperative individualized counseling regarding optimal treatment approaches (e.g., operative vs nonoperative), complication risks with surgery, durability of surgery, and likelihood of achieving individualized patient goals and satisfaction. Despite the challenges associated with the current state-of-the-art ASD treatment, surgery continues to be a primary option, as multiple reports have demonstrated the potential for surgery to significantly improve pain and disability. The future of ASD care will likely include techniques and technologies to markedly reduce complication rates, including greater use of navigation and robotics, and a shift toward individualized medicine that enables improved counseling, preoperative planning, procedure safety, and patient satisfaction.Advances in the care of ASD patients have been remarkable over the past few decades. The current state of the art enables almost routine surgical treatment for many types of ASD that have the potential to significantly improve pain and disability. However, significant challenges remain, including high complication rates, lack of demonstrated cost-effectiveness, and limited ability to meaningfully counsel patients preoperatively on an individual basis. The future of ASD surgery will require continued improvement of predictability, safety, and sustainability.

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“…4 Classificação dos procedimentos de realinhamento da coluna anterior. 23 Rev Bras Ortop com necessidade de descompressão ampla e possibilidade de instabilidade, se o equilíbrio sagital e coronal estiverem preservados, a artrodese apenas do segmento abordado deve ser considerada. 29 Em pacientes com risco de pseudoartrose e programação de artrodese longa, a associação de artrodese intersomática é benéfica, sobretudo em níveis lombares baixos, caso seja realizada fusão lombossacra.…”

Section: Tratamento Cirúrgicounclassified

Escoliose degenerativa do adulto

Cristante

Silva

Costa

et al. 2020

Rev Bras Ortop (Sao Paulo)

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ResumoO envelhecimento da população aumenta a incidência dos processos degenerativos osteomusculares, como a escoliose do adulto (EA). A EA é definida como uma deformidade da coluna no plano coronal com ângulo de Cobb > 10° e pode ocorrer devido a um processo degenerativo (escoliose de novo), evolução de uma escoliose pré-existente ou de forma iatrogênica.A EA é uma doença potencialmente limitante que acomete um grupo heterogêneo de pacientes. O tratamento clínico se mostrou pouco efetivo e a indicação cirúrgica é frequente. No presente artigo, é apresentada uma revisão sobre a fisiopatologia, a manifestação clínica e o diagnóstico da EA. Também são apresentadas as indicações cirúrgicas e as principais técnicas utilizadas atualmente.

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The comprehensive anatomical spinal osteotomy and anterior column realignment classification

Cited by 57 publications

References 41 publications

Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment

Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment

Treatment of adult thoracolumbar spinal deformity: past, present, and future

Escoliose degenerativa do adulto

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