Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment
Jakub Godzik, Bernardo de Andrada Pereira, Courtney Hemphill, Corey T. Walker, Joshua T. Wewel, Jay D. Turner, Juan S. Uribe
Abstract
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.