Adult sagittal plane alignment is the result of an intricate interaction between the spine and pelvis. The development of a sagittal spine deformity results in a series of compensatory mechanisms including increase in pelvic tilt, hip extensor overutilization, and knee and ankle flexion. When these natural mechanisms fail, patients may develop symptomatic sagittal imbalance, which ultimately affects their function and quality of life.
Traditional techniques to address sagittal spine deformity include posterior-based spine osteotomies to restore the sagittal balance. Historically, however, these techniques have been associated with a high morbidity, long operative times, and excessive blood loss.
This chapter focuses on the treatment of sagittal spinal deformity using a novel minimally invasive technique, anterior column realignment (ACR). The technique utilizes a retroperitoneal approach to the lumbar spine with lateral interbody fusion after transecting the anterior longitudinal ligament (ALL) to restore focal sagittal alignment. The preliminary report of our first 17 patients has shown promising short-term results. Attention to case selection and technical pearls of the ACR is of utmost importance to achieve desirable outcomes and avoid catastrophic complications.
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