{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:18:52Z","timestamp":1792034332793,"version":"4.4.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2012,11]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>In the surgical treatment of spinal deformities, the importance of restoring lumbar lordosis is well recognized. Smith-Petersen osteotomies (SPOs) yield approximately 10\u00b0 of lordosis per level, whereas pedicle subtraction osteotomies result in as much as 30\u00b0 increased lumbar lordosis. Recently, selective release of the anterior longitudinal ligament (ALL) and placement of lordotic interbody grafts using the minimally invasive lateral retroperitoneal transpsoas approach (XLIF) has been performed as an attempt to increase lumbar lordosis while avoiding the morbidity of osteotomy. The objective of the present study was to measure the effect of the selective release of the ALL and varying degrees of lordotic implants placed using the XLIF approach on segmental lumbar lordosis in cadaveric specimens between L-1 and L-5.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Nine adult fresh-frozen cadaveric specimens were placed in the lateral decubitus position. Lateral radiographs were obtained at baseline and after 4 interventions at each level as follows: 1) placement of a standard 10\u00b0 lordotic cage, 2) ALL release and placement of a 10\u00b0 lordotic cage, 3) ALL release and placement of a 20\u00b0 lordotic cage, and 4) ALL release and placement of a 30\u00b0 lordotic cage. All four cages were implanted sequentially at each interbody level between L-1 and L-5. Before and after each intervention, segmental lumbar lordosis was measured in all specimens at each interbody level between L-1 and L-5 using the Cobb method on lateral radiography.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The mean baseline segmental lordotic angles at L1\u20132, L2\u20133, L3\u20134, and L4\u20135 were \u20133.8\u00b0, 3.8\u00b0, 7.8\u00b0, and 22.6\u00b0, respectively. The mean lumbar lordosis was 29.4\u00b0. Compared with baseline, the mean postimplantation increase in segmental lordosis in all levels combined was 0.9\u00b0 in Intervention 1 (10\u00b0 cage without ALL release); 4.1\u00b0 in Intervention 2 (ALL release with 10\u00b0 cage); 9.5\u00b0 in Intervention 3 (ALL release with 20\u00b0 cage); and 11.6\u00b0 in Intervention 4 (ALL release with 30\u00b0 cage). Foraminal height in the same sequence of conditions increased by 6.3%, 4.6%, 8.8% and 10.4%, respectively, while central disc height increased by 16.1%, 22.3%, 52.0% and 66.7%, respectively. Following ALL release and placement of lordotic cages at all 4 lumbar levels, the average global lumbar lordosis increase from preoperative lordosis was 3.2\u00b0 using 10\u00b0 cages, 12.0\u00b0 using 20\u00b0 cages, and 20.3\u00b0 using 30\u00b0 cages. Global lumbar lordosis with the cages at 4 levels exhibited a negative correlation with preoperative global lordosis (10\u00b0, R = \u22120.756; 20\u00b0, \u22120.730; and 30\u00b0, R = \u22120.437).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Combined ALL release and placement of increasingly lordotic lateral interbody cages leads to progressive gains in segmental lordosis in the lumbar spine. Mean global lumbar lordosis similarly increased with increasingly lordotic cages, although the effect with a single cage could not be evaluated. Greater global lordosis was achieved with smaller preoperative lordosis. The mean maximum increase in segmental lordosis of 11.6\u00b0 followed ALL release and placement of the 30\u00b0 cage.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.8.spine111121","type":"journal-article","created":{"date-parts":[[2012,9,1]],"date-time":"2012-09-01T16:14:09Z","timestamp":1346516049000},"page":"476-485","source":"Crossref","is-referenced-by-count":108,"title":["Lordosis restoration after anterior longitudinal ligament release and placement of lateral hyperlordotic interbody cages during the minimally invasive lateral transpsoas approach: a radiographic study in cadavers"],"prefix":"10.3171","volume":"17","author":[{"given":"Juan S.","family":"Uribe","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of South Florida, Tampa, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald A.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Florida, Tampa, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Dakwar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of South Florida, Tampa, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali A.","family":"Baaj","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory M.","family":"Mundis","sequence":"additional","affiliation":[{"name":"San Diego Center for Spinal Disorders, La Jolla; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander W. 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