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Anterior Column Realignment (ACR): Minimally Invasive Surgery for the Treatment of Adult Sagittal Plane Deformity

  • Gregory M. MundisJr.
  • Pooria Hosseini
  • Amrit Khalsa
  • Behrooz A. Akbarnia
Chapter

Abstract

Adult sagittal plane alignment is the result of an intricate interaction between the spine and pelvis. The development of a sagittal spine deformity results in a series of compensatory mechanisms including increase in pelvic tilt, hip extensor overutilization, and knee and ankle flexion. When these natural mechanisms fail, patients may develop symptomatic sagittal imbalance, which ultimately affects their function and quality of life.

Traditional techniques to address sagittal spine deformity include posterior-based spine osteotomies to restore the sagittal balance. Historically, however, these techniques have been associated with a high morbidity, long operative times, and excessive blood loss.

This chapter focuses on the treatment of sagittal spinal deformity using a novel minimally invasive technique, anterior column realignment (ACR). The technique utilizes a retroperitoneal approach to the lumbar spine with lateral interbody fusion after releasing the anterior longitudinal ligament (ALL) and annulus to restore focal sagittal alignment. Attention to case selection and technical pearls of the ACR is of utmost importance to achieve desirable outcomes and avoid catastrophic complications.

Keywords

Anterior column realignment Sagittal imbalance Anterior longitudinal ligament Lateral lumbar interbody fusion 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Gregory M. MundisJr.
    • 1
    • 2
    • 3
  • Pooria Hosseini
    • 2
  • Amrit Khalsa
    • 3
  • Behrooz A. Akbarnia
    • 2
  1. 1.Scripps Clinic Torrey PinesLa JollaUSA
  2. 2.Department of OrthopedicsSan Diego Spine FoundationSan DiegoUSA
  3. 3.Department of OrthopedicsScripps HospitalLa JollaUSA

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