title: Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study.
abstract: BACKGROUND
  Adult deformity combined with sagittal malalignment is a pathology that decreases patient's quality of life and that requires surgical correction to achieve clinical improvement. Spine osteotomies are usually performed to restore alignment of the spine, even if these techniques are associated with high intraoperative risks, revision rates and relevant mortality rates. Anterior column realignment (ACR) is a new technique that allows large corrections through a minimally invasive lateral approach to the spine after release of the anterior longitudinal ligament.
  
  
  METHODS
  Preoperative and postoperative full-standing X-rays of 12 patients who underwent ACR procedure were retrospectively reviewed. Spinopelvic alignment parameters of sagittal balance were measured on standing full-spine radiographs. Any intraoperative or postoperative complication was reported, as technical notes such the number of treated levels, associated XLIFs and cases of revision surgery.
  
  
  RESULTS
  11 out of 12 patients had a complete data set and were enrolled in this study. The mean preoperative and postoperative lumbar lordosis values were, respectively, -20° ± 17° and -51° ± 9.8° (p < 0.001), while a mean value of 27° of lordosis were restored at a single ACR level. Two major complications occurred, a bowel perforation and a postoperative early infection of the posterior wound that required surgical debridement.
  
  
  CONCLUSIONS
  Preliminary data show that ACR allows corrections similar to those obtained with a Pedicle Subtraction Osteotomy, avoiding risks related to this technique.
authors.affiliation: IVth Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy, pberjano@gmail.com.
authors.forename: Pedro
authors.initials: P
authors.lastname: Berjano
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cecchinato
authors.forename: Aldo
authors.initials: A
authors.lastname: Sinigaglia
authors.forename: Marco
authors.initials: M
authors.lastname: Damilano
authors.forename: Maryem-Fama
authors.initials: MF
authors.lastname: Ismael
authors.forename: Carlotta
authors.initials: C
authors.lastname: Martini
authors.forename: Jorge Hugo
authors.initials: JH
authors.lastname: Villafañe
authors.forename: Claudio
authors.initials: C
authors.lastname: Lamartina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D017846:Longitudinal Ligaments / Q000601:surgery; D008141:Lordosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011788:Quality of Life; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013530:Surgical Wound Infection; D016896:Treatment Outcome