Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA.
Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Eur Spine J. 2022 Sep;31(9):2196-2203. doi: 10.1007/s00586-021-07100-y. Epub 2022 Jan 3.
Expansion of the anterior column and compression of the posterior column restores lordosis and sagittal imbalance. Anterior longitudinal ligament (ALL) release has been described from lateral and anterior approaches as a technique to improve lumbar lordosis; however, posterior approach to release the ALL has not been adequately assessed.
We demonstrate a case series of ALL release using a posterior approach performed in conjunction with posterior column osteotomy (PCO), with or without transforaminal lumbar interbody fusion (TLIF) for spinal deformity. Eleven cases were identified from billing records between 2010 and 2019. Retrospective review was conducted for perioperative complications and revision surgery. Overall and segmental lumbar lordosis (LL) correction was measured from pre- and postoperative imaging.
Eleven patients underwent ALL release with a PCO. Kyphosis, scoliosis, and flat back syndrome were the most common spinal deformities. On average, patients had 9 ± 3 levels fused and a single level ALL release. ALL release was most commonly performed at L1-L2 and L2-L3 levels. An overall LL correction of 28.6° ± 19.8 was achieved; ALL release introduced 16.7° ± 11.9° of lordotic correction and accounted for 49.2 ± 30.4% of the overall lordotic correction. Average blood loss was 1030 ± 573 mL.
ALL release as an adjunct to PCO and TLIF is a viable technique for providing increased deformity correction without subjecting the patient to a more invasive three-column osteotomy. While this approach may not be appropriate for all patients, it represents a useful option in spinal deformity correction while limiting blood loss and additional anterior surgery.
IV.
通过扩大前柱并压缩后柱来恢复脊柱前凸和矢状面失衡。前纵韧带（ALL）松解术已通过侧方和前方入路来描述，作为改善腰椎前凸的一种技术；然而，后路松解 ALL 尚未得到充分评估。
我们展示了一系列使用后路入路进行 ALL 松解的病例，该入路与后路后柱截骨术（PCO）联合进行，对于脊柱畸形患者，联合后路 PCO 或经椎间孔腰椎体间融合术（TLIF）。在 2010 年至 2019 年的计费记录中确定了 11 例病例。对围手术期并发症和翻修手术进行回顾性研究。从术前和术后影像学测量总体和节段性腰椎前凸（LL）矫正。
11 例患者接受了后路 PCO 联合 ALL 松解术。后凸畸形、脊柱侧凸和平背综合征是最常见的脊柱畸形。平均患者融合了 9 ± 3 个节段，仅在一个节段进行 ALL 松解。ALL 松解最常发生在 L1-L2 和 L2-L3 水平。总体 LL 矫正为 28.6°±19.8°；ALL 松解术引入了 16.7°±11.9°的前凸矫正，占总体前凸矫正的 49.2±30.4%。平均失血量为 1030±573ml。
后路 PCO 和 TLIF 联合 ALL 松解术是一种可行的技术，可提供更大的畸形矫正，而无需使患者接受更具侵袭性的三柱截骨术。虽然这种方法可能并不适合所有患者，但它在脊柱畸形矫正中是一种有用的选择，同时限制了失血和额外的前路手术。
IV。
