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Short-segment minimally disruptive anterior column release for focal sagittal deformity correction of the thoracolumbar spine

BACKGROUND: Sagittal malalignment is associated with poor quality of life. Correction of lumbar lordosis through anterior column release (ACR) has been shown to improve overall sagittal alignment, however typically in combination with long posterior constructs and associated morbidity. The technical...

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Autores principales: Tohmeh, Antoine G., Jabbouri, Sahir S., Vesselle, Alexandre, Howell, Kelli M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820079/
https://www.ncbi.nlm.nih.gov/pubmed/35141633
http://dx.doi.org/10.1016/j.xnsj.2021.100068
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author Tohmeh, Antoine G.
Jabbouri, Sahir S.
Vesselle, Alexandre
Howell, Kelli M.
author_facet Tohmeh, Antoine G.
Jabbouri, Sahir S.
Vesselle, Alexandre
Howell, Kelli M.
author_sort Tohmeh, Antoine G.
collection PubMed
description BACKGROUND: Sagittal malalignment is associated with poor quality of life. Correction of lumbar lordosis through anterior column release (ACR) has been shown to improve overall sagittal alignment, however typically in combination with long posterior constructs and associated morbidity. The technical feasibility and radiographic outcomes of short-segment anterior or lateral minimally invasive surgery (MIS) ACR techniques in moderate to severe lumbar sagittal deformity were evaluated. METHODS: Consecutive patients treated with short-segment MIS ACR techniques for moderate to severe lumbar sagittal deformity correction were retrospectively analyzed from a prospectively collected database. Clinical outcomes included perioperative measures of invasiveness, including operative time, blood loss, complications, and average length of stay. Radiographic outcomes included measurement of preoperative, immediate postoperative, and long-term follow-up radiographic parameters including coronal Cobb angle, lumbar lordosis (LL), pelvic incidence (PI), PI-LL mismatch, pelvic tilt (PT), T1 pelvic angle (TPA), T1 spino-pelvic inclination (T1SPI), proximal junctional angle (PJA), and sagittal vertical axis (SVA). RESULTS: The cohort included 34 patients (mean age 63) who were treated at an average 2.5 interbody levels (range 1-4) through a lateral or anterior approach (LLIF or ALIF). Of 89 total interbody levels treated, 63 (71%) were ACR levels. Posterior fixation was across an average of 3.2 levels (range 1-5). Mean total operative time and blood loss were 362 minutes and 621 mL. Surgical complications occurred in 2 (5.9%). Average hospital stay was 5.5 days (including staging). At last follow-up (average 25.4 months; range 0.5-7 years), all patients (100%) demonstrated successful achievement of one or more alignment goal, with significant improvements in coronal Cobb, LL, PI-LL mismatch, PT, and TPA. No patient was revised for PJK. CONCLUSIONS: These data show that short-segment MIS ACR correction of moderate to severe lumbar sagittal deformity is feasible and effective at achieving overall alignment goals with low procedural morbidity and risk of proximal junctional issues.
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spelling pubmed-88200792022-02-08 Short-segment minimally disruptive anterior column release for focal sagittal deformity correction of the thoracolumbar spine Tohmeh, Antoine G. Jabbouri, Sahir S. Vesselle, Alexandre Howell, Kelli M. N Am Spine Soc J Clinical Case Studies BACKGROUND: Sagittal malalignment is associated with poor quality of life. Correction of lumbar lordosis through anterior column release (ACR) has been shown to improve overall sagittal alignment, however typically in combination with long posterior constructs and associated morbidity. The technical feasibility and radiographic outcomes of short-segment anterior or lateral minimally invasive surgery (MIS) ACR techniques in moderate to severe lumbar sagittal deformity were evaluated. METHODS: Consecutive patients treated with short-segment MIS ACR techniques for moderate to severe lumbar sagittal deformity correction were retrospectively analyzed from a prospectively collected database. Clinical outcomes included perioperative measures of invasiveness, including operative time, blood loss, complications, and average length of stay. Radiographic outcomes included measurement of preoperative, immediate postoperative, and long-term follow-up radiographic parameters including coronal Cobb angle, lumbar lordosis (LL), pelvic incidence (PI), PI-LL mismatch, pelvic tilt (PT), T1 pelvic angle (TPA), T1 spino-pelvic inclination (T1SPI), proximal junctional angle (PJA), and sagittal vertical axis (SVA). RESULTS: The cohort included 34 patients (mean age 63) who were treated at an average 2.5 interbody levels (range 1-4) through a lateral or anterior approach (LLIF or ALIF). Of 89 total interbody levels treated, 63 (71%) were ACR levels. Posterior fixation was across an average of 3.2 levels (range 1-5). Mean total operative time and blood loss were 362 minutes and 621 mL. Surgical complications occurred in 2 (5.9%). Average hospital stay was 5.5 days (including staging). At last follow-up (average 25.4 months; range 0.5-7 years), all patients (100%) demonstrated successful achievement of one or more alignment goal, with significant improvements in coronal Cobb, LL, PI-LL mismatch, PT, and TPA. No patient was revised for PJK. CONCLUSIONS: These data show that short-segment MIS ACR correction of moderate to severe lumbar sagittal deformity is feasible and effective at achieving overall alignment goals with low procedural morbidity and risk of proximal junctional issues. Elsevier 2021-05-09 /pmc/articles/PMC8820079/ /pubmed/35141633 http://dx.doi.org/10.1016/j.xnsj.2021.100068 Text en © 2021 The Author(s). Published by Elsevier Ltd on behalf of North American Spine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Case Studies
Tohmeh, Antoine G.
Jabbouri, Sahir S.
Vesselle, Alexandre
Howell, Kelli M.
Short-segment minimally disruptive anterior column release for focal sagittal deformity correction of the thoracolumbar spine
title Short-segment minimally disruptive anterior column release for focal sagittal deformity correction of the thoracolumbar spine
title_full Short-segment minimally disruptive anterior column release for focal sagittal deformity correction of the thoracolumbar spine
title_fullStr Short-segment minimally disruptive anterior column release for focal sagittal deformity correction of the thoracolumbar spine
title_full_unstemmed Short-segment minimally disruptive anterior column release for focal sagittal deformity correction of the thoracolumbar spine
title_short Short-segment minimally disruptive anterior column release for focal sagittal deformity correction of the thoracolumbar spine
title_sort short-segment minimally disruptive anterior column release for focal sagittal deformity correction of the thoracolumbar spine
topic Clinical Case Studies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820079/
https://www.ncbi.nlm.nih.gov/pubmed/35141633
http://dx.doi.org/10.1016/j.xnsj.2021.100068
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