Anterior Column Realignment: Analysis of Neurological Risk and Radiographic Outcomes. Issue 3 (16th April 2020)

• Record Type: Journal Article
• Authors: Saigal, Rajiv; Akbarnia, Behrooz A; Eastlack, Robert K; Bagheri, Ali; Tran, Stacie; Brown, Drew; Bagheri, Ramin; Mundis, Gregory M
• Is Part Of: Neurosurgery. Volume 87:Issue 3(2020)
• Page Start: E347
• Page End: E354
• Publication Date: 2020-04-16
• Subjects: Anterior column realignment -- Sagittal imbalance -- PI-LL mismatch -- Minimally invasive -- Adult spinal deformity; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa064
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Anterior column realignment (ACR) is a less invasive alternative to 3-column osteotomy for the correction of sagittal imbalance. We hypothesized that ACR would correct sagittal imbalance with an acceptable neurological risk. OBJECTIVE: To assess long-term neurological and radiographic outcomes after ACR. METHODS: Patients ≥18 yr who underwent ACR from 2005 to 2013 were eligible. Standing scoliosis radiographs were studied at preoperation, postoperation (≤6 wk), and at minimum 2 yr of follow-up. Clinical/radiographic data were collected through a retrospective chart review, with thoracic 1 spino-pelvic inclination (T1SPi) used as the angular surrogate for sagittal vertical axis. RESULTS: A total of 26 patients had complete data, with a mean follow-up of 2.8 yr (1.8-7.4). Preoperative, sagittal parameters were lumbar lordosis (LL) of −16.1°, pelvic incidence (PI)-LL of 41.7°, T1SPi of 3.6°, and pelvis tilt (PT) of 32.4°. LL improved by 30.6° ( P < .001) postoperation. Mean changes in PT (−8.3), sacral slope (8.9), T1SPi (−4.9), and PI-LL (−33.5) were all significant. The motion segment angle improved by 26.6°, from 5.2° to −21.4° ( P < .001). Neurological complications occurred in 32% patients postoperation (n = 8; 1 patient with both sensory and motor). New thigh numbness/paresthesia developed in 3 (13%) patients postoperation; only 1 (4%) persisted at latest follow-up. A total of 6 (24%) patients developed a new lower extremity motor deficit postoperation, with 4 (8%) having persistent new weakness at last follow-up. Out of 8 patients with preoperative motor deficit, half saw improvement postoperation and 75% improved by last follow-up. CONCLUSION: There was net motor improvement, with 24% of patients improving and 16% having persistent new weakness at latest follow-up; 60% were unchanged. Radiographic results demonstrate that ACR is a useful tool to treat severe sagittal plane deformity. Graphical Abstract: