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Anterior Column Reconstruction for Sagittal Plane Deformity Correction

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Minimally Invasive Spine Surgery

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Abstract

Since the addition of the lateral access corridor to the spinal surgeon’s armamentarium, indications for its applications have broadened over time. Classically, spine surgeons have employed the minimally invasive (MIS) transpsoas lateral lumbar interbody fusion (LLIF) approach to treat degenerative disc disease and low-grade spondylolisthesis. However, with an increasing demand for effective MIS tools in spinal deformity surgery, surgeons have focused on advanced techniques for restoring sagittal balance through the lateral corridor. The MIS lateral anterior column reconstruction (ACR) is being used as a lordosing technique that may obviate the need for osteotomies (vertebral column resection, pedicle subtraction osteotomy) in appropriately selected deformity patients. Release of the anterior longitudinal ligament (ALL) enables anterior column wedging to induce lumbar lordosis, providing a potential MIS option for treating moderate to severe sagittal plane deformity. In this chapter, we discuss the nuances of the anatomy and surgical technique of the MIS lateral ACR, review the available literature, present the results of our experience with this technique, and highlight the associated dangers and complications.

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References

  1. Agur AM, Dalley AF, editors. Grant’s atlas of anatomy. Baltimore: Lippincott Williams & Wilkins; 2009.

    Google Scholar 

  2. Nielsen FH, editor. Atlas of human anatomy. 2nd ed. Basel: Novartis; 1997.

    Google Scholar 

  3. Vidic BFR, editor. Photographic atlas of the human body. St Louis: Mosby; 1984.

    Google Scholar 

  4. Marchi L, Pimenta L, Oliveira L, Fortti F, Amaral R, Abdala N. Distance between great vessels and the lumbar spine: MRI study for anterior longitudinal ligament release through a lateral approach. J Neurol Surg A Cent Eur Neurosurg. 2017;78(2):144–53.

    PubMed  Google Scholar 

  5. Stulik J, Vyskocil T, Bodlak P, Sebesta P, Kryl J, Vojacek J, et al. Injury to major blood vessels in anterior thoracic and lumbar spinal surgery. Acta Chir Orthop Traumatol Cechoslov. 2006;73(2):92–8.

    CAS  Google Scholar 

  6. Lolis E, Panagouli E, Venieratos D. Study of the ascending lumbar and iliolumbar veins: surgical anatomy, clinical implications and review of the literature. Ann Anat. 2011;193(6):516–29.

    Article  Google Scholar 

  7. Arslan M, Comert A, Acar HI, Ozdemir M, Elhan A, Tekdemir I, et al. Surgical view of the lumbar arteries and their branches: an anatomical study. Neurosurgery. 2011;68(1 Suppl Operative):16–22; discussion.

    PubMed  Google Scholar 

  8. Deukmedjian AR, Le TV, Dakwar E, Martinez CR, Uribe JS. Movement of abdominal structures on magnetic resonance imaging during positioning changes related to lateral lumbar spine surgery: a morphometric study: clinical article. J Neurosurg Spine. 2012;16(6):615–23.

    Article  Google Scholar 

  9. Uribe JS, Isaacs RE, Youssef JA, Khajavi K, Balzer JR, Kanter AS, et al. Can triggered electromyography monitoring throughout retraction predict postoperative symptomatic neuropraxia after XLIF? Results from a prospective multicenter trial. Eur Spine J. 2015;24(Suppl 3):378–85.

    Article  Google Scholar 

  10. Cummock MD, Vanni S, Levi AD, Yu Y, Wang MY. An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion. J Neurosurg Spine. 2011;15(1):11–8.

    Article  Google Scholar 

  11. Spiegel DA, Cunningham BW, Oda I, Dormans JP, McAfee PC, Drummond DS. Anterior vertebral screw strain with and without solid interspace support. Spine. 2000;25(21):2755–61.

    Article  CAS  Google Scholar 

  12. Cunningham BW, Polly DW Jr. The use of interbody cage devices for spinal deformity: a biomechanical perspective. Clin Orthop Relat Res. 2002;394:73–83.

    Article  Google Scholar 

  13. Anderson DG, Sayadipour A, Shelby K, Albert TJ, Vaccaro AR, Weinstein MS. Anterior interbody arthrodesis with percutaneous posterior pedicle fixation for degenerative conditions of the lumbar spine. Eur Spine J. 2011;20(8):1323–30.

    Article  Google Scholar 

  14. Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: state-of-the-art technical advances. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, March 2004. J Neurosurg Spine. 2004;1(1):24–30.

    Article  Google Scholar 

  15. Castellvi AE, Nienke TW, Marulanda GA, Murtagh RD, Santoni BG. Indirect decompression of lumbar stenosis with transpsoas interbody cages and percutaneous posterior instrumentation. Clin Orthop Relat Res. 2014;472(6):1784–91.

    Article  Google Scholar 

  16. Elowitz EH, Yanni DS, Chwajol M, Starke RM, Perin NI. Evaluation of indirect decompression of the lumbar spinal canal following minimally invasive lateral transpsoas interbody fusion: radiographic and outcome analysis. Minim Invasive Neurosurg: MIN. 2011;54(5–6):201–6.

    CAS  PubMed  Google Scholar 

  17. Marulanda GA, Nayak A, Murtagh R, Santoni BG, Billys JB, Castellvi AE. A cadaveric radiographic analysis on the effect of extreme lateral interbody fusion cage placement with supplementary internal fixation on indirect spine decompression. J Spinal Disord Tech. 2014;27(5):263–70.

    Article  Google Scholar 

  18. Oliveira L, Marchi L, Coutinho E, Pimenta L. A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine. 2010;35(26 Suppl):S331–7.

    Article  Google Scholar 

  19. Uribe JS, Smith DA, Dakwar E, Baaj AA, Mundis GM, Turner AW, et al. Lordosis restoration after anterior longitudinal ligament release and placement of lateral hyperlordotic interbody cages during the minimally invasive lateral transpsoas approach: a radiographic study in cadavers. J Neurosurg Spine. 2012;17(5):476–85.

    Article  Google Scholar 

  20. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine. 2005;30(18):2024–9.

    Article  Google Scholar 

  21. Deukmedjian AR, Le TV, Baaj AA, Dakwar E, Smith DA, Uribe JS. Anterior longitudinal ligament release using the minimally invasive lateral retroperitoneal transpsoas approach: a cadaveric feasibility study and report of 4 clinical cases. J Neurosurg Spine. 2012;17(6):530–9.

    Article  Google Scholar 

  22. Akbarnia BA, Mundis GM Jr, Moazzaz P, Kabirian N, Bagheri R, Eastlack RK, et al. Anterior column realignment (ACR) for focal kyphotic spinal deformity using a lateral transpsoas approach and ALL release. J Spinal Disord Tech. 2014;27(1):29–39.

    Article  Google Scholar 

  23. Berjano P, Cecchinato R, Sinigaglia A, Damilano M, Ismael MF, Martini C, et al. Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study. Eur Spine J. 2015;24(Suppl 3):433–8.

    Article  Google Scholar 

  24. Murray G, Beckman J, Bach K, Smith DA, Dakwar E, Uribe JS. Complications and neurological deficits following minimally invasive anterior column release for adult spinal deformity: a retrospective study. Eur Spine J. 2015;24(Suppl 3):397–404.

    Article  Google Scholar 

  25. Turner JD, Akbarnia BA, Eastlack RK, Bagheri R, Nguyen S, Pimenta L, et al. Radiographic outcomes of anterior column realignment for adult sagittal plane deformity: a multicenter analysis. Eur Spine J. 2015;24(Suppl 3):427–32.

    Article  Google Scholar 

  26. Deukmedjian AR, Dakwar E, Ahmadian A, Smith DA, Uribe JS. Early outcomes of minimally invasive anterior longitudinal ligament release for correction of sagittal imbalance in patients with adult spinal deformity. Sci World J. 2012;2012:789698.

    Article  Google Scholar 

  27. Marchi L, Oliveira L, Amaral R, Castro C, Coutinho T, Coutinho E, et al. Anterior elongation as a minimally invasive alternative for sagittal imbalance-a case series. HSS J. 2012;8(2):122–7.

    Article  Google Scholar 

  28. Mummaneni PV, Shaffrey CI, Lenke LG, Park P, Wang MY, La Marca F, et al. The minimally invasive spinal deformity surgery algorithm: a reproducible rational framework for decision making in minimally invasive spinal deformity surgery. Neurosurg Focus. 2014;36(5):E6.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Saint Luke’s Hospital and Marion Bloch Neuroscience Institute, Kansas City, MO, USA

    Gurpreet S. Gandhoke

  2. Mayfield Brain & Spine, Cincinnati, OH, USA

    Zachary J. Tempel

  3. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Adam S. Kanter

Authors
  1. Gurpreet S. Gandhoke
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  2. Zachary J. Tempel
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  3. Adam S. Kanter
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Corresponding author

Correspondence to Adam S. Kanter .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips

  2. Texas Back Institute Texas Health Presbyterian Hospital Plano Scoliosis and Spine Tumor Center, Plano, TX, USA

    Isador H. Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

  4. Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA

    Michael Y. Wang

Appendices

Quiz Questions

True/False

  1. 1.

    The lateral transpsoas approach for an anterior column resection provides for a minimally invasive option to increase the lordosis of the lumbar spine and potentially avoid the morbidity of a pedicle subtraction osteotomy.

  2. 2.

    A 30-degree hyperlordotic cage used after an anterior column resection at the L2–L3 level provides a corresponding additional 30 degrees of lumbar lordosis.

  3. 3.

    When planning a surgical approach to performing an ACR, it is important to realize that the inferior vena cava and the iliac veins tend to become more closely associated with the anterior aspect of the lumbar spine at the convexity of a coronal curve in the lumbar spine.

Answers

  1. 1.

    True

  2. 2.

    False

  3. 3.

    True

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Gandhoke, G.S., Tempel, Z.J., Kanter, A.S. (2019). Anterior Column Reconstruction for Sagittal Plane Deformity Correction. In: Phillips, F., Lieberman, I., Polly Jr., D., Wang, M. (eds) Minimally Invasive Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19007-1_27

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  • DOI: https://doi.org/10.1007/978-3-030-19007-1_27

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-19006-4

  • Online ISBN: 978-3-030-19007-1

  • eBook Packages: MedicineMedicine (R0)

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