Abstract
Three-column osteotomies (3COs) can achieve significant alignment correction when revising fixed sagittal plane deformities; however, the technique is associated with high complication rates. The authors demonstrate staged anterior-posterior surgery with L5–S1 ALIF (below a prior L3–5 fusion) and multilevel Smith-Petersen osteotomies to circumvent the morbidity associated with 3CO. The patient was a 67-year-old male with three prior lumbar surgeries who presented with back and leg pain. Imaging demonstrated lumbar flat back deformity and sagittal imbalance. The narrated video details key radiological measurements, operative planning and rationale, surgical steps, and outcomes. The patient provided written, informed consent for publication of this illustrative case.The video can be found here: https://youtu.be/wv4W9D9fUPc.
Highlights
Three-column osteotomies are useful for revision spine surgery but have high complication rates
We planned to perform a staged anterior-posterior approach with an ALIF at L5–S1 and a posterior revision from T10 to pelvis with Smith-Petersen osteotomies above the prior L3–5 fusion
Standing scoliosis films were obtained on postoperative day 3
Summary
Three-column osteotomies are useful for revision spine surgery but have high complication rates. KEYWORDS adult spinal deformity; anterior lumbar interbody fusion; flatback deformity; revision spine surgery; scoliosis; video To avoid this morbid technique, we used a staged anterior-posterior approach with L5–S1 ALIF and multilevel Smith-Petersen osteotomies for deformity correction. He had three prior lumbar surgeries including a posterior instrumented arthrodesis from L3 to L5. Standing scoliosis films demonstrated global coronal alignment and a thoracolumbar major curve measuring approximately 17°.
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