Anterior longitudinal ligament release from a posterior approach: an alternative to three-column osteotomy

Purpose 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 re...

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Bibliographic Details
Published in:European spine journal 2022-09, Vol.31 (9), p.2196-2203
Main Authors: Han, Nathan, Pratt, Nathan, Usmani, M. Farooq, Hayman, Erik, Jones, Salazar, Johnsen, Parker, Thomson, Alexandra E., Ye, Ivan, Chryssikos, Timothy, Sharma, Ashish, Olexa, Joshua, Cavanaugh, Daniel L., Koh, Eugene Y., Buraimoh, Kendall, Ludwig, Steven, Sansur, Charles
Format: Article
Language:English
Subjects:
Compression
Data collection
Kyphosis
Ligaments
Medicine
Medicine & Public Health
Neurosurgery
Orthopedics
Osteotomy
Patients
Scoliosis
Supplement Article
Surgery
Surgical Orthopedics
Surgical techniques
Vertebrae
X-rays
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Summary:Purpose 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. Methods 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. Results 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 o 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. Conclusions 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. Level of Evidence IV
ISSN:0940-6719
1432-0932
DOI:10.1007/s00586-021-07100-y