Anterior Column Realignment (ACR) for Focal Kyphotic Spinal Deformity Using a Lateral Transpsoas Approach and ALL Release

Akbarnia, Behrooz A.; Mundis, Gregory M.; Moazzaz, Payam; Kabirian, Nima; Bagheri, Ramin; Eastlack, Robert K.; Pawelek, Jeff

doi:10.1097/bsd.0b013e318287bdc1

Cited by 126 publications

(62 citation statements)

References 17 publications

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“…A modification of the LLIF technique known as ACR (anterior column resection) or LIFTAR (lateral interbody fusion with transpsoas ALL release) had been reported as a way to gain larger increases in lordosis with this approach. 27,28 In our series, purposeful sectioning of the ALL was not performed in any of the LLIF cases.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Comparison of Lateral Lumbar Interbody Fusion Versus Traditional Fusion Approaches: Analysis of Sagittal Contour Change

et al. 2015

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Background Lateral approach to lumbar fusion has been gaining popularity in recent years. With increasing awareness of the significance of sagittal balance restoration in spinal surgery, it is important to investigate the potential of this relatively new approach in correcting sagittal deformities in comparison to conventional approaches. The aim of this study was to evaluate sagittal contour changes seen in lateral lumbar interbody fusion and compare them with radiographic changes in traditional approaches to lumbar fusion.

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Section: Discussionmentioning

confidence: 99%

Radiographic Comparison of Lateral Lumbar Interbody Fusion Versus Traditional Fusion Approaches: Analysis of Sagittal Contour Change

et al. 2015

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“…1,13,14,35,37 For example, Deukmedjian et al 13 used the lateral transpsoas approach to release the anterior longitudinal ligament and place a hyperlordotic interbody cage in 7 patients, gaining an average of 17° per level of anterior longitudinal ligament release. Similar results were described by Akbarnia et al 1 and Uribe et al, 35 who discovered a 21° increase in lumbar lordosis and a 10°-20° increase in segmental lordosis, respectively, with anterior column realignment. Wang and Madhavan 37 used a posterior approach for a minimally invasive pedicle subtraction osteotomy, which resulted in a 15-cm correction of the SVA.…”

Section: Discussionmentioning

confidence: 99%

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Uribe

Deukmedjian

Mummaneni³

et al. 2014

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134

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Object It is hypothesized that minimally invasive surgical techniques lead to fewer complications than open surgery for adult spinal deformity (ASD). The goal of this study was to analyze matched patient cohorts in an attempt to isolate the impact of approach on adverse events. Methods Two multicenter databases queried for patients with ASD treated via surgery and at least 1 year of follow-up revealed 280 patients who had undergone minimally invasive surgery (MIS) or a hybrid procedure (HYB; n = 85) or open surgery (OPEN; n = 195). These patients were divided into 3 separate groups based on the approach performed and were propensity matched for age, preoperative sagittal vertebral axis (SVA), number of levels fused posteriorly, and lumbar coronal Cobb angle (CCA) in an attempt to neutralize these patient variables and to make conclusions based on approach only. Inclusion criteria for both databases were similar, and inclusion criteria specific to this study consisted of an age > 45 years, CCA > 20°, 3 or more levels of fusion, and minimum of 1 year of follow-up. Patients in the OPEN group with a thoracic CCA > 75° were excluded to further ensure a more homogeneous patient population. Results In all, 60 matched patients were available for analysis (MIS = 20, HYB = 20, OPEN = 20). Blood loss was less in the MIS group than in the HYB and OPEN groups, but a significant difference was only found between the MIS and the OPEN group (669 vs 2322 ml, p = 0.001). The MIS and HYB groups had more fused interbody levels (4.5 and 4.1, respectively) than the OPEN group (1.6, p < 0.001). The OPEN group had less operative time than either the MIS or HYB group, but it was only statistically different from the HYB group (367 vs 665 minutes, p < 0.001). There was no significant difference in the duration of hospital stay among the groups. In patients with complete data, the overall complication rate was 45.5% (25 of 55). There was no significant difference in the total complication rate among the MIS, HYB, and OPEN groups (30%, 47%, and 63%, respectively; p = 0.147). No intraoperative complications were reported for the MIS group, 5.3% for the HYB group, and 25% for the OPEN group (p < 0.03). At least one postoperative complication occurred in 30%, 47%, and 50% (p = 0.40) of the MIS, HYB, and OPEN groups, respectively. One major complication occurred in 30%, 47%, and 63% (p = 0.147) of the MIS, HYB, and OPEN groups, respectively. All patients had significant improvement in both the Oswestry Disability Index (ODI) and visual analog scale scores after surgery (p < 0.001), although the MIS group did not have significant improvement in leg pain. The occurrence of complications had no impact on the ODI. Conclusions Results in this study suggest that the surgical approach may impact complications. The MIS group had significantly fewer intraoperative complications than did either the HYB or OPEN groups. If the goals of ASD surgery can be achieved, consideration should be given to less invasive techniques.

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“…Deukmedjian et al (31) in their series of 7 patients showed an increase in segmental lordosis of 17 degrees with ALL released and the use of hyperlordosis cages via XLIF approach. Similarly, Akbarina et al (32) reported lordotic improvement up to 23 degrees in their series of 17 patients. However, it must be recognized that several patients underwent simultaneous pedicle subtraction osteotomy in conjunction with hyperlordosis cages and ALL release, confounding data extrapolation.…”

Section: Segmental Lordosismentioning

confidence: 97%

Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

Winder¹,

Gambhir²

2016

J. Spine Surg.

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The incidence of lumbar fusion for the treatment of various degenerative lumbar spine diseases has increased dramatically over the last twenty years. Many lumbar fusion techniques have been developed and popularized, each with its own advantages and disadvantages. Anterior lumbar interbody fusion (ALIF) initially introduced in the 1930's, has become a common and widely accepted technique for lumbar fusions over the last decade offering several advantages over standard posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF). More recently, the lateral trans-psoas approach termed extreme, direct or lateral lumbar interbody fusion (XLIF, DLIF, LLIF) is gaining widespread popularity.The aim of this paper is to compare the approaches, advantages and disadvantages of ALIF and XLIF for L4/5 interbody fusion based on relevant literature.

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Anterior Column Realignment (ACR) for Focal Kyphotic Spinal Deformity Using a Lateral Transpsoas Approach and ALL Release

Cited by 126 publications

References 17 publications

Radiographic Comparison of Lateral Lumbar Interbody Fusion Versus Traditional Fusion Approaches: Analysis of Sagittal Contour Change

Radiographic Comparison of Lateral Lumbar Interbody Fusion Versus Traditional Fusion Approaches: Analysis of Sagittal Contour Change

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

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