Anterior Column Realignment (ACR) With and Without Pre-ACR Posterior Release for Fixed Sagittal Deformity

Jeffrey M. Hills; S. Tim Yoon; John M. Rhee; Dheera Ananthakrishnan; Elliot Kim; Keith W. Michael; Byron Stephens

doi:10.14444/6026

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Anterior Column Realignment (ACR) With and Without Pre-ACR Posterior Release for Fixed Sagittal Deformity

Journal article

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Anterior Column Realignment (ACR) With and Without Pre-ACR Posterior Release for Fixed Sagittal Deformity

Jeffrey M. Hills, S. Tim Yoon, John M. Rhee, Dheera Ananthakrishnan, Elliot Kim, Keith W. Michael and Byron Stephens

International journal of spine surgery, Vol.13(2), pp.192-198

04/01/2019

DOI: 10.14444/6026

PMCID: PMC6510191

PMID: 31131220

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Abstract

Background: Multiple studies have demonstrated a strong correlation between sagittal malalignment and health-related quality of life measures. Thus, correction of sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis-pelvic incidence (LL-PI), and TI spinopelvic inclination (TISPi) have become a primary objective of adult spinal deformity surgery. Anterior column realignment (ACR) has emerged as a less invasive technique and while the addition of posterior osteotomies has shown greater correction in ACR, it is unknown if a pre-ACR posterior release is necessary for optimal correction. The purpose of this study was to determine if pre-ACR posterior release allows for greater sagittal deformity correction. Methods: Seventeen patients were identified that underwent minimum 1-level ACR. Ten patients underwent an anterior-posterior surgical sequence without a pre-ACR posterior release, and 7 underwent a posterior-anteriorposterior (PAP) sequence with a pre-ACR posterior release. Radiographic outcomes at final follow-up and complications were compared. Results: Both groups saw significant improvements in LL, LL-PI, PT, SVA, and T1SPi but the correction was not significantly different between cohorts. With the exception of PT in the PAP group, the improvements in LL-PI, PT, and SVA correlated to improvement in Scoliosis Research Society-Schwab classification. The correction achieved at the ACR level, represented by motion segment angle, was greater in the PAP group by a degree that approached statistical significance. Five patients (29%) had 6 complications. Conclusions: Both techniques achieved meaningful improvements in overall sagittal alignment. Our results suggest that a pre-ACR posterior release may allow for greater correction specifically at the ACR level but may not always be necessary to achieve clinically meaningful correction of sagittal plane deformity.

Life Sciences & Biomedicine

Science & Technology

Surgery

Details

Title: Subtitle: Anterior Column Realignment (ACR) With and Without Pre-ACR Posterior Release for Fixed Sagittal Deformity
Creators: Jeffrey M. Hills - Vanderbilt University Medical Center
S. Tim Yoon - Emory University Orthopaedics and Spine Hospital
John M. Rhee - Emory University Orthopaedics and Spine Hospital
Dheera Ananthakrishnan - Emory University Orthopaedics and Spine Hospital
Elliot Kim - Emory University Orthopaedics and Spine Hospital
Keith W. Michael - Emory University Orthopaedics and Spine Hospital
Byron Stephens - Vanderbilt University Medical Center
Resource Type: Journal article
Publication Details: International journal of spine surgery, Vol.13(2), pp.192-198
DOI: 10.14444/6026
PMID: 31131220
PMCID: PMC6510191
NLM abbreviation: Int J Spine Surg
ISSN: 2211-4599
eISSN: 2211-4599
Publisher: Int Soc Advancement Spine Surgery-Isass
Number of pages: 7
Language: English
Date published: 04/01/2019
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9985167564502771

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