Anterior Elongation as a Minimally Invasive Alternative for Sagittal Imbalance - A Case Series

Luis Marchi, MS
Department of Imaging Diagnosis, Universidad Federal de Sao Paulo, Brazil
Department of Minimally Invasive Surgery, Instituto de Patologia da Coluna, Brazil

Leonardo Oliveira, BS
Department of Minimally Invasive Surgery, Instituto de Patologia da Coluna, Brazil

Rodrigo Amaral, MD
Department of Minimally Invasive Surgery, Instituto de Patologia da Coluna, Brazil

Carlos Castro, MD
Department of Minimally Invasive Surgery, Instituto de Patologia da Coluna, Brazil

Thiago Coutinho, MD
Department of Minimally Invasive Surgery, Instituto de Patologia da Coluna, Brazil

Etevaldo Coutinho, MD
Department of Minimally Invasive Surgery, Instituto de Patologia da Coluna, Brazil

Luiz Pimenta, MD, PhD
Department of Neurosugery, University of California, California
Department of Minimally Invasive Surgery, Instituto de Patologia da Coluna, Brazil


Abstract

Background

Degenerative and iatrogenic conditions may lead to flat back or even to kyphotic deformity, and sagittal imbalance can cause significant clinical impairment. Minor imbalance cases are usually treated with conservative care. Among currently popular surgical techniques for the correction of sagittal imbalance are posterior-based procedures, which are associated with access-related risks (mostly neurological) and postoperative morbidity risks.

Purpose

This study aims to report a minimally invasive lateral approach using hyperlordotic cages in the treatment of mild sagittal imbalance. Radiological correction, clinical improvement, and safety will be analyzed.

Methods

Eight patients (mean age 71.8 years, SD 7.8; mean BMI 27.5, SD 2.3) with symptomatic sagittal imbalance were retrospectively reviewed. Eight cases were treated by anterior interbody fusion with lordotic cages. A minimally invasive lateral retroperitoneal approach was used in the surgical procedures, with or without percutaneous pedicle screw supplementation.

Results

No major complications occurred and just one case needed revision for direct decompression. Clinical outcomes Visual Analog Scale score changed from 88 at preoperative visit to 51 at 1-week visit, and Oswestry Disability Index score decreased from 82 at preoperative visit to 44 at 6-week visit. The 6-month radiological assessment revealed improvement in spinopelvic parameters: Focal lordosis improved from 2.3°±7.7 to 27.1°±6.7. Sagittal vertical alignment improved from 11.7±5.3 to 6.2±4.0 cm. Preoperative sacral slope improved from 20.1°±5.8 to 29.4°±10.3 and preoperative pelvic tilt improved from 35.2°±5.2 to 23.8°±4.3. Short-term results indicate that the minimally invasive lateral approach can be applied to the treatment of mild sagittal imbalance, with special advantage in elderly patients or those in which posterior approaches are relatively contraindicated.

This article appears in HSS Journal: Volume 8, Number 2.
View the full article at springerlink.com.
Erratum: See Corrected Table

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

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