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HSS Journal ®
Published in: HSS Journal ® 2/2012

01-07-2012 | Original Article

Anterior Elongation as a Minimally Invasive Alternative for Sagittal Imbalance—A Case Series

Authors: Luis Marchi, MS, Leonardo Oliveira, BS, Rodrigo Amaral, MD, Carlos Castro, MD, Thiago Coutinho, MD, Etevaldo Coutinho, MD, Luiz Pimenta, MD, PhD

Published in: HSS Journal ® | Issue 2/2012

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Abstract

Background

Degenerative and iatrogenic conditions may lead to flat back or even to kyphotic deformity, and sagittal imbalance can cause significant clinical impairment. Minor imbalance cases are usually treated with conservative care. Among currently popular surgical techniques for the correction of sagittal imbalance are posterior-based procedures, which are associated with access-related risks (mostly neurological) and postoperative morbidity risks.

Purpose

This study aims to report a minimally invasive lateral approach using hyperlordotic cages in the treatment of mild sagittal imbalance. Radiological correction, clinical improvement, and safety will be analyzed.

Methods

Eight patients (mean age 71.8 years, SD 7.8; mean BMI 27.5, SD 2.3) with symptomatic sagittal imbalance were retrospectively reviewed. Eight cases were treated by anterior interbody fusion with lordotic cages. A minimally invasive lateral retroperitoneal approach was used in the surgical procedures, with or without percutaneous pedicle screw supplementation.

Results

No major complications occurred and just one case needed revision for direct decompression. Clinical outcomes Visual Analog Scale score changed from 88 at preoperative visit to 51 at 1-week visit, and Oswestry Disability Index score decreased from 82 at preoperative visit to 44 at 6-week visit. The 6-month radiological assessment revealed improvement in spinopelvic parameters: Focal lordosis improved from 2.3° ± 7.7 to 27.1° ± 6.7. Sagittal vertical alignment improved from 11.7 ± 5.3 to 6.2 ± 4.0 cm. Preoperative sacral slope improved from 20.1° ± 5.8 to 29.4° ± 10.3 and preoperative pelvic tilt improved from 35.2° ± 5.2 to 23.8° ± 4.3. Short-term results indicate that the minimally invasive lateral approach can be applied to the treatment of mild sagittal imbalance, with special advantage in elderly patients or those in which posterior approaches are relatively contraindicated.
Literature
1.
Benglis DM, Elhammady MS, Levi AD, Vanni S. Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity. Neurosurgery. 2008 set;63(3 Suppl):191–196.PubMedCrossRef
2.
Bergey DL, Villavicencio AT, Goldstein T, Regan JJ. Endoscopic lateral transpsoas approach to the lumbar spine. Spine. 2004 ago 1;29(15):1681–1688.PubMedCrossRef
3.
Billinghurst J, Akbarnia BA. Extreme lateral interbody fusion - XLIF. Current Orthopaedic Practice. 2009;20(3):238–251.CrossRef
4.
Bridwell KH, Lewis SJ, Edwards C, Lenke LG, Iffrig TM, Berra A, et al. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine. 2003 set 15;28(18):2093–2101.PubMedCrossRef
5.
Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am. 2003 mar;85-A(3):454–463.PubMed
6.
Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine. 2006 set 1;31(19 Suppl):S171-178.PubMedCrossRef
7.
Bridwell KH. Causes of sagittal spinal imbalance and assessment of the extent of needed correction. Instr Course Lect. 2006;55:567–575.PubMed
8.
Cho K-J, Bridwell KH, Lenke LG, Berra A, Baldus C. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine. 2005 set 15;30(18):2030–2037; discussion 2038.PubMedCrossRef
9.
Chow DH, Luk KD, Evans JH, Leong JC. Effects of short anterior lumbar interbody fusion on biomechanics of neighboring unfused segments. Spine. 1996 mar 1;21(5):549–555.PubMedCrossRef
10.
Dakwar E, Cardona RF, Smith DA, Uribe JS. Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurgical FOCUS. 2010 mar;28(3):E8.
11.
Dezawa A, Yamane T, Mikami H, Miki H. Retroperitoneal laparoscopic lateral approach to the lumbar spine: a new approach, technique, and clinical trial. J Spinal Disord. 2000 abr;13(2):138–143.PubMedCrossRef
12.
Hyun S-J, Rhim S-C. Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients : a long-term follow-up data. J Korean Neurosurg Soc. 2010 fev;47(2):95–101.PubMedCrossRef
13.
Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM. A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine. 2010 dez 15;35(26 Suppl):S322-330.PubMedCrossRef
14.
Jang J-S, Lee S-H, Min J-hong, Maeng DH. Changes in sagittal alignment after restoration of lower lumbar lordosis in patients with degenerative flat back syndrome. J Neurosurg Spine. 2007 out;7(4):387–392.PubMedCrossRef
15.
Karikari IO, Grossi PM, Nimjee SM, Hardin C, Hodges TR, Hughes BD, et al. Minimally Invasive Lumbar Interbody Fusion in Patients Over Seventy Years of Age: analysis of peri- and post-operative complications. Neurosurgery. 2011 abr;68(4):897–902.PubMed
16.
Kim K-T, Park K-J, Lee J-H. Osteotomy of the spine to correct the spinal deformity. Asian Spine J. 2009 dez;3(2):113–123.PubMedCrossRef
17.
Klopfenstein JD, Kim LJ, Feiz-Erfan I, Dickman CA. Retroperitoneal approach for lumbar interbody fusion with anterolateral instrumentation for treatment of spondylolisthesis and degenerative foraminal stenosis. Surg Neurol. 2006 fev;65(2):111–116; discussion 116.PubMedCrossRef
18.
19.
Kostuik JP, Maurais GR, Richardson WJ, Okajima Y. Combined single stage anterior and posterior osteotomy for correction of iatrogenic lumbar kyphosis. Spine. 1988 mar;13(3):257–266.PubMedCrossRef
20.
Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J. 2001 ago;10(4):314–319.PubMedCrossRef
21.
Lazennec JY, Ramaré S, Arafati N, Laudet CG, Gorin M, Roger B, et al. Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J. 2000 fev;9(1):47–55.PubMedCrossRef
22.
Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 1998;7(2):99–103.PubMedCrossRef
23.
Mundis GM, Akbarnia BA, Phillips FM. Adult Deformity Correction Through Minimally Invasive Lateral Approach Techniques. Spine. 2010 dez;35(Supplement):S312-S321.PubMedCrossRef
24.
Oliveira L, Marchi L, Coutinho E, Abdala N, Pimenta L. The use of rh-BMP2 in Standalone eXtreme Lateral Interbody Fusion (XLIF®): Clinical and Radiological Results After 24 Months Follow-up. WSCJ. 2010;1(1):19–25.
25.
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 dez;35(Supplement):S331-S337.PubMedCrossRef
26.
Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. The Spine Journal. 2006;6(4):435–443.PubMedCrossRef
27.
Rodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine. 2011 jan 1;36(1):26–32.PubMedCrossRef
28.
Rodgers WB, Cox C, Gerber E. Experience and Early Results with a Minimally Invasive Technique for Anterior Column Support Through eXtreme Lateral Interbody Fusion (XLIF®). US Musculoskelet Rev. 2007;2:28–32.
29.
30.
Rodgers WB, Gerber EJ, Rodgers JA. Lumbar Fusion in Octogenarians. Spine. 2010 dez;35(Supplement):S355-S360.PubMedCrossRef
31.
Roussouly P, Nnadi C. Sagittal plane deformity: an overview of interpretation and management. Eur Spine J. 2010 nov;19(11):1824–1836.PubMedCrossRef
32.
33.
Smith WD, Dakwar E, Le TV, Christian G, Serrano S, Uribe JS. Minimally Invasive Surgery for Traumatic Spinal Pathologies. Spine. 2010 dez;35(Supplement):S338-S346.PubMedCrossRef
34.
Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res 1969 out;66:6–9.PubMed
35.
Vaz G, Roussouly P, Berthonnaud E, Dimnet J. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J. 2002 fev;11(1):80–87.PubMedCrossRef
36.
Wang MY, Mummaneni PV. Minimally invasive surgery for thoracolumbar spinal deformity: Initial clinical experience with clinical and radiographic outcomes. Neurosurgical Focus. 2010;28(3):1–8.CrossRef
37.
Weinhoffer SL, Guyer RD, Herbert M, Griffith SL. Intradiscal pressure measurements above an instrumented fusion. A cadaveric study. Spine. 1995 mar 1;20(5):526–531.PubMedCrossRef
38.
Yang BP, Ondra SL, Chen LA, Jung HS, Koski TR, Salehi SA. Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. J Neurosurg Spine. 2006 jul;5(1):9–17.PubMedCrossRef
39.
Youssef JA, McAfee PC, Patty CA, Raley E, DeBauche S, Shucosky E, et al. Minimally Invasive Surgery: Lateral Approach Interbody Fusion. Spine. 2010 dez;35(Supplement):S302-S311.PubMedCrossRef
Metadata
Title
Anterior Elongation as a Minimally Invasive Alternative for Sagittal Imbalance—A Case Series
Authors
Luis Marchi, MS
Leonardo Oliveira, BS
Rodrigo Amaral, MD
Carlos Castro, MD
Thiago Coutinho, MD
Etevaldo Coutinho, MD
Luiz Pimenta, MD, PhD
Publication date
01-07-2012
Publisher
Springer-Verlag
Published in
HSS Journal ® / Issue 2/2012
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-011-9226-z

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