Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study

Introduction Adult deformity combined with sagittal malalignment is a pathology that decreases patient's quality of life and that requires surgical correction to achieve clinical improvement. Spine osteotomies are usually performed to restore alignment of the spine, even if these techniques are associated with high intraoperative risks, revision rates and relevant mortality rates. Anterior column realignment (ACR) is a new technique that allows large corrections through a minimally invasive lateral approach to the spine after release of the anterior longitudinal ligament. Materials and methods Preoperative and postoperative full-standing X-rays of 12 patients who underwent ACR procedure were retrospectively reviewed. Spinopelvic alignment parameters of sagittal balance were measured on standing full-spine radiographs. Any intraoperative or postoperative complication was reported, as technical notes such the number of treated levels, associated XLIFs and cases of revision surgery. Results 11 out of 12 patients had a complete data set and were enrolled in this study. The mean preoperative and postoperative lumbar lordosis values were, respectively, -20 +/- 17 degrees and -51 +/- 9.8 degrees (p < 0.001), while a mean value of 27 degrees of lordosis were restored at a single ACR level. Two major complications occurred, a bowel perforation and a postoperative early infection of the posterior wound that required surgical debridement. Conclusions Preliminary data show that ACR allows corrections similar to those obtained with a Pedicle Subtraction Osteotomy, avoiding risks related to this technique.