PT  - JOURNAL ARTICLE
AU  - HILLS, JEFFREY M.
AU  - YOON, S. TIM
AU  - RHEE, JOHN M.
AU  - ANANTHAKRISHNAN, DHEERA
AU  - KIM, ELLIOT
AU  - MICHAEL, KEITH W.
AU  - STEPHENS, BYRON
TI  - Anterior Column Realignment (ACR) With and Without Pre-ACR Posterior Release for Fixed Sagittal Deformity
AID  - 10.14444/6026
DP  - 2019 Apr 01
TA  - International Journal of Spine Surgery
PG  - 192--198
VI  - 13
IP  - 2
4099  - https://www.ijssurgery.com/content/13/2/192.short
4100  - https://www.ijssurgery.com/content/13/2/192.full
SO  - Int J Spine Surg2019 Apr 01; 13
AB  - Background: Multiple studies have demonstrated a strong correlation between sagittal malalignment and health-related quality of life measures. Thus, correction of sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis–pelvic incidence (LL-PI), and T1 spinopelvic inclination (T1SPi) have become a primary objective of adult spinal deformity surgery. Anterior column realignment (ACR) has emerged as a less invasive technique and while the addition of posterior osteotomies has shown greater correction in ACR, it is unknown if a pre-ACR posterior release is necessary for optimal correction. The purpose of this study was to determine if pre-ACR posterior release allows for greater sagittal deformity correction.Methods: Seventeen patients were identified that underwent minimum 1-level ACR. Ten patients underwent an anterior-posterior surgical sequence without a pre-ACR posterior release, and 7 underwent a posterior-anterior-posterior (PAP) sequence with a pre-ACR posterior release. Radiographic outcomes at final follow-up and complications were compared.Results: Both groups saw significant improvements in LL, LL-PI, PT, SVA, and T1SPi but the correction was not significantly different between cohorts. With the exception of PT in the PAP group, the improvements in LL-PI, PT, and SVA correlated to improvement in Scoliosis Research Society–Schwab classification. The correction achieved at the ACR level, represented by motion segment angle, was greater in the PAP group by a degree that approached statistical significance. Five patients (29%) had 6 complications.Conclusions: Both techniques achieved meaningful improvements in overall sagittal alignment. Our results suggest that a pre-ACR posterior release may allow for greater correction specifically at the ACR level but may not always be necessary to achieve clinically meaningful correction of sagittal plane deformity.Level of Evidence: 3Clinical Relevance: We present our experience with and without pre-ACR posterior release. To our knowledge, this is the first study to show that pre-ACR posterior release may achieve greater correction at the ACR level.