Murray Gisela, Beckman Joshua, Bach Konrad, Smith Donald A, Dakwar Elias, Uribe Juan S
University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL, 33606, USA.
Eur Spine J. 2015 Apr;24 Suppl 3:397-404. doi: 10.1007/s00586-015-3894-1. Epub 2015 Apr 8.
Minimally invasive techniques have become increasing popular and are expanding into deformity surgery. The lateral retroperitoneal transpsoas anterior column release (ACR) is a newer minimally invasive alternative to posterior osteotomy techniques for correcting and promoting global spinal alignment. This procedure attempts to avoid the potential complications associated with conventional osteotomies, but has its own subset of unique complications to be discussed in depth.
A retrospective review was performed in all patients who underwent the minimally invasive (MIS) ACR procedure from 2010 to present at our institution. All perioperative and postoperative complications were recorded by an independent reviewer. Demographics, spinopelvic parameters, and operative data were collected. The primary etiologic diagnosis was adult spinal deformity. Spinopelvic parameters were measured based on standing 36-inch scoliosis films.
Thirty-one patients underwent a total of 47 MIS-ACRs. The mean age of the cohort was 62. Mean follow up was 12 months (range 3-38 months). The average change from in lumbar lordosis (LL) was 17.6°, in pelvic tilt was 4.3°, coronal Cobb was 13.9 and in SVA was 3.8 cm. Of the 47 MIS-ACR procedures, there were 9 (9/47, 19 %) major complications related to the ACR. Iliopsoas weakness was seen in eight patients and retrograde ejaculation in one patient. Only one patient remained with mild motor deficit at the most recent follow-up. No revision surgeries were required for the anterolateral approach. There was no vascular, visceral, or infectious complications associated with the MIS-ACR.
The MIS-ACR is one of the most technically demanding procedures performed from the lateral transpsoas approach. This procedure has the advantage of maintaining and improving spinal global alignment while minimizing blood loss and excessive tissue dissection. It comes with its own unique set of potentially catastrophic complications and should only be performed by surgeons proficient in both deformity correction and the lateral approach.
微创技术越来越受欢迎，并正在扩展到畸形手术领域。外侧腹膜后经腰大肌前路椎体松解术（ACR）是一种较新的微创方法，可替代后路截骨术来矫正和促进脊柱整体对线。该手术试图避免与传统截骨术相关的潜在并发症，但也有其自身独特的一系列并发症需要深入讨论。
对2010年至今在本机构接受微创（MIS）ACR手术的所有患者进行回顾性研究。所有围手术期和术后并发症均由一名独立审查员记录。收集人口统计学、脊柱骨盆参数和手术数据。主要病因诊断为成人脊柱畸形。脊柱骨盆参数基于站立位36英寸脊柱侧弯X线片测量。
31例患者共接受了47次MIS-ACR手术。队列的平均年龄为62岁。平均随访时间为12个月（范围3 - 38个月）。腰椎前凸（LL）平均变化为17.6°，骨盆倾斜平均变化为4.3°，冠状面Cobb角为13.9°，矢状面垂直轴（SVA）为3.8 cm。在47次MIS-ACR手术中，有9例（9/47，19%）与ACR相关的主要并发症。8例患者出现髂腰肌无力，1例患者出现逆行射精。在最近一次随访时，只有1例患者仍有轻度运动功能障碍。前路外侧入路无需翻修手术。MIS-ACR未出现血管、内脏或感染相关并发症。
MIS-ACR是经腰大肌外侧入路进行的技术要求最高的手术之一。该手术的优点是在尽量减少失血和过度组织分离的同时，维持和改善脊柱整体对线。它有其自身独特的一系列潜在灾难性并发症，应由精通畸形矫正和外侧入路的外科医生进行操作。
