Anterior Column Realignment in Adult Spinal Deformity: A Case Report and Review of the Literature.

OBJECTIVE: Anterior column realignment (ACR) is a new emerging minimally invasive surgical technique in adult spinal deformity (ASD) that has the potential to provide similar corrective ability to traditional posterior approaches. This paper reviews the current literature on the clinical efficacy and safety of ACR and illustrates an additional utilization of this technique in a case of sagittal imbalance following posterior spinal fusion with segmental instrumentation.

METHODS: We performed a literature search of all published ACR reports using PubMed, including only clinical papers describing the ACR technique and reporting radiographic and/or clinical outcomes.

RESULTS: Thirteen studies were included. Improvement in lumbar lordosis following ACR ranged from 12.7° to 39°, with increases in focal segmental lordosis at each ACR level ranged from 1° to 34°. Good clinical and functional outcomes have consistently been reported following ACR. The complication rate has been comparable or lower than traditional posterior-based techniques. We also illustrate the use of ACR in a patient with sagittal imbalance following a prior posterior instrumented spinal fusion. ACR in combination with a posterior osteotomy allowed for the induction of lordosis by cantilevering of rods and compression of pedicle screws.

CONCLUSIONS: Radiographic and clinical outcomes following ACR have been promising so far. In addition to primary ASD surgery, ACR can also be effectively used in cases with prior posterior instrumented spinal fusion to correct sagittal imbalance.