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

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Minimally Invasive Spine Surgery

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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 transecting the anterior longitudinal ligament (ALL) to restore focal sagittal alignment. The preliminary report of our first 17 patients has shown promising short-term results. Attention to case selection and technical pearls of the ACR is of utmost importance to achieve desirable outcomes and avoid catastrophic complications.

Disclosures

Drs. Gregory M. Mundis and Behrooz A. Akbarnia are paid consultants of the NuVasive®, Inc.

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Author information

Authors and Affiliations

  1. Department of Spine Surgery, San Diego Center for Spinal Disorders, La Jolla, CA, USA

    Gregory M. Mundis Jr. MD & Nima Kabirian MD

  2. Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA

    Behrooz A. Akbarnia MD

Authors
  1. Gregory M. Mundis Jr. MD
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  2. Nima Kabirian MD
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  3. Behrooz A. Akbarnia MD
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Corresponding author

Correspondence to Gregory M. Mundis Jr. MD .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA

    Frank Phillips

  2. Scoliosis and Spine Tumor Center, Texas Back Institutes, Texas Health Presbyterian Hospital Plano, Plano, Texas, USA

    Isador Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA

    David Polly

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Mundis, G.M., Kabirian, N., Akbarnia, B.A. (2014). Anterior Column Realignment (ACR): Minimally Invasive Surgery for the Treatment of Adult Sagittal Plane Deformity. In: Phillips, F., Lieberman, I., Polly, D. (eds) Minimally Invasive Spine Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5674-2_30

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  • DOI: https://doi.org/10.1007/978-1-4614-5674-2_30

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5673-5

  • Online ISBN: 978-1-4614-5674-2

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