Anterior Column Release (ACR) during Lateral Interbody Fusion for Hyperlordotic Segmental Correction

Presented at SMISS Annual Forum 2018
By Larry Khoo MD
With Roya Gheissari MS, Charlie Loeb ,

Disclosures: Larry Khoo MD B; Globus Spine, Zimmer Biomet, Medacta Spine, Burst Biologics. F; Globus Spine, Zimmer Biomet Roya Gheissari MS None, Charlie Loeb None,

Introduction:

Evidence to maximize segmental lumbar lordosis (LL) during spinal fusion to optimize LL and Pelvic Parameters continues to grow steadily. ACR represents the next evolution of traditional lateral lumbar interbody fusion (LLIF) techniques.

Aims/Objectives:

We sought to assess the safety, efficacy, and morbidity of the ACR technique in LLIF

Methods:

In a prospective study, 72 patients with segmental listhesis and sagittal imbalance were treated via LLIF during which ACR and implantation of a hyperlordotic fusion cage were completed. Same stage posterior arthrodesis and fixation were also done. Peri-operative data, radiographic and clinical outcomes were collected.

Results:

Preoperative data: mean age 67, BMI 28.5, CMI 1.6, T-scores -0.6, ODI 44, VAS leg 8.5, VAS back 9.75. OR data: Surgical time- 65 minutes (LLIF) 53 min (PSF/decompression), ebl total 75cc, LOS 2.5 days, Complications (major 1.5%, minor 8.3%)- 1 vascular, 4 transient psoas praxia (avg 2.5 wks), 1 wound dehiscence, 1 abdominal hernia, transfusions 1. Clinical Outcomes: 12 mo ODI change -23, VAS back -6.5, VAS leg -7.5. 53 cases used fixed cages of 20 degrees (22 avg) lordosis. 19 cases utilized an expandable and variable angle titanium cage (20-30 degree final). Radiographic Outcomes: Lordotic correction +19.5 immediate postop (16.5 fixed, 22.3 expandable), 18.2 deg at 6 months, 17.8 deg correction at 12 mos, Pelvic tilts improved at -9.5 deg postop, -13.2 at 6 months and -14.1 at 12 mos. Rigid fusion with 1 yr dynamic xrays and CT scan was observed in 67/72 (93%) with 5/72 demonstrating stable pseudoarthrosis.

Conclusions:

Instrumented ACR with or without expandable interbody implants represents a ready, far less-invasive and morbid alternative to traditional osteotomy deformity correction techniques.