Mundis Gregory M, Turner Jay D, Kabirian Nima, Pawelek Jeff, Eastlack Robert K, Uribe Juan, Klineberg Eric, Bess Shay, Ames Chris, Deviren Vedat, Nguyen Stacie, Lafage Virginie, Akbarnia Behrooz A
Department of Orthopaedics, Scripps Clinic, La Jolla, California, USA.
Department of Neurosurgery, Barrow Neurologic Institute, Phoenix, Arizona, USA.
World Neurosurg. 2017 Sep;105:249-256. doi: 10.1016/j.wneu.2017.05.122. Epub 2017 May 27.
Anterior column realignment (ACR) is a minimally invasive surgical technique used for the correction of adult sagittal plane deformity. ACR is performed via a minimally invasive lateral transpsoas approach with anterior longitudinal ligament release and hyperlordotic cage placement. The objective of this study was to compare radiographic outcomes and complications in patients treated by ACR or Pedicle subtraction osteotomy (PSO).
Patients who underwent ACR were matched with patients from a retrospective PSO dataset, by pelvic incidence, lumbar lordosis, and thoracic kyphosis. Inclusion criteria included pelvic incidence and lumbar lordosis mismatch > 10°, pelvic tilt > 25°, and/or C7 sagittal vertical axis >5 cm, and minimum 1-year follow-up.
All (n = 17) patients who underwent ACR underwent second-stage open posterior instrumented fusion. There were no differences in baseline demographic or radiographic parameters. Both groups were found to have significant improvement from preoperative to final follow-up for lumbar lordosis, T1 spinopelvic inclination, and T1 pelvic angle. Pelvic tilt did not improve with PSO (31° to 28°) at final follow-up but did improve in ACR group (34° to 25°). No differences were identified at 3-month or final follow-up for lumbar lordosis (51° vs. 47°), pelvic tilt (25° vs. 28°), and T1 pelvic angle (23° vs. 24°). The group undergoing PSO achieved greater T1 spinopelvic inclination correction (8° vs. 1.9°). Patients who underwent ACR had significantly less estimated blood loss than patients who underwent PSO (1.6 vs. 3.6 L, respectively), but no difference in the overall major complication rates was found (35.3% vs. 41.2%, respectively).
ACR achieved similar radiographic results as PSO in a matched cohort with significantly less estimated blood loss and similar overall complication rate.
前路柱重排（ACR）是一种用于矫正成人矢状面畸形的微创手术技术。ACR通过微创经腰大肌外侧入路进行，同时松解前纵韧带并置入前凸椎间融合器。本研究的目的是比较接受ACR或经椎弓根截骨术（PSO）治疗的患者的影像学结果和并发症。
将接受ACR治疗的患者与来自回顾性PSO数据集的患者，按照骨盆入射角、腰椎前凸和胸椎后凸进行匹配。纳入标准包括骨盆入射角与腰椎前凸不匹配>10°、骨盆倾斜>25°和/或C7矢状垂直轴>5 cm，以及至少1年的随访。
所有接受ACR治疗的患者（n = 17）均接受了二期后路切开内固定融合术。两组患者的基线人口统计学和影像学参数无差异。两组患者从术前到最终随访时，腰椎前凸、T1脊柱骨盆倾斜度和T1骨盆角均有显著改善。PSO组在最终随访时骨盆倾斜度未改善（从31°到28°），而ACR组有所改善（从34°到25°）。在3个月或最终随访时，腰椎前凸（51°对47°）、骨盆倾斜度（25°对28°）和T1骨盆角（23°对24°）均无差异。接受PSO治疗的组在T1脊柱骨盆倾斜度矫正方面更大（8°对1.9°）。接受ACR治疗的患者估计失血量明显少于接受PSO治疗的患者（分别为1.6 L对3.6 L），但总体主要并发症发生率无差异（分别为35.3%对41.2%）。
在匹配队列中，ACR与PSO取得了相似的影像学结果，估计失血量显著减少，总体并发症发生率相似。
