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

Abstract

Anterior column realignment (ACR) is a new emerging minimally invasive surgical technique for adult spinal deformity (ASD) that has the potential to provide similar corrective ability to traditional posterior approaches. This article reviews the current literature on the clinical efficacy and safety of ACR and illustrates an additional use of this technique in a case of sagittal imbalance after posterior spinal fusion with segmental instrumentation. We performed a literature search of all published ACR reports using PubMed, including only clinical studies describing the ACR technique and reporting radiographic and/or clinical outcomes. Thirteen studies were included. Improvement in lumbar lordosis after ACR ranged from 12.7° to 39°, and increases in focal segmental lordosis at each ACR level ranged from 1° to 34°. Good clinical and functional outcomes have consistently been reported after ACR. The complication rate has been comparable to or lower than traditional posterior-based techniques. We also illustrate the use of ACR in a patient with sagittal imbalance after 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. Radiographic and clinical outcomes after 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.