{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:18:29Z","timestamp":1792034309625,"version":"4.4.0"},"reference-count":162,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,8]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Pedicle subtraction osteotomy (PSO) provides extensive correction in patients with fixed sagittal plane imbalance but is associated with high estimated blood loss (EBL). Anterior column realignment (ACR) with lateral graft placement and sectioning of the anterior longitudinal ligament allows restoration of lumbar lordosis (LL). The authors compare peri- and postoperative measures in 2 groups of patients undergoing correction of a sagittal plane imbalance, either through PSO or the use of lateral lumbar fusion and ACR with hyperlordotic (20\u00b0\u201330\u00b0) interbody cages, with stabilization through standard posterior instrumentation in all cases.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors performed a retrospective chart review of cases involving a lumbar PSO or lateral lumbar interbody fusion and ACR (LLIF-ACR) between 2010 and 2015 at the authors\u2019 institution. Patients who had a PSO in the setting of a preexisting fusion that spanned more than 4 levels were excluded. Demographic characteristics, spinopelvic parameters, EBL, operative time, and LOS were analyzed and compared between patients treated with PSO and those treated with LLIF-ACR.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The PSO group included 14 patients and the LLIF-ACR group included 13 patients. The mean follow-up was 13 months in the LLIF-ACR group and 26 months in the PSO group. The mean EBL was significantly lower in the LLIF-ACR group, measuring approximately 50% of the mean EBL in the PSO group (1466 vs 2910 ml, p < 0.01). Total LL correction was equivalent between the 2 groups (35\u00b0 in the PSO group, 31\u00b0 in the LLIF-ACR group, p > 0.05), as was the preoperative PI-LL mismatch (33\u00b0 in each group, p > 0.05) and the postoperative PI-LL mismatch (< 1\u00b0 in each group, p = 0.05). The fusion rate as assessed by the need for reoperation due to pseudarthrosis was lower in the LLIF-ACR group but not significantly so (3 revisions in the PSO group due to pseudarthrosis vs 0 in the LLIF-ACR group, p > 0.5). The total operative time and LOS were not significantly different in the 2 groups.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This is the first direct comparison of the LLIF-ACR technique with the PSO in adult spinal deformity correction. The study demonstrates that the LLIF-ACR provides equivalent deformity correction with significantly reduced blood loss in patients with a previously unfused spine compared with the PSO. This technique provides a powerful means to avoid PSO in selected patients who require spinal deformity correction.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2017.5.focus17195","type":"journal-article","created":{"date-parts":[[2017,8,1]],"date-time":"2017-08-01T03:36:48Z","timestamp":1501558608000},"page":"E15","source":"Crossref","is-referenced-by-count":44,"title":["Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy"],"prefix":"10.3171","volume":"43","author":[{"given":"Jean-Christophe","family":"Leveque","sequence":"first","affiliation":[{"name":"Neuroscience Institute, Virginia Mason Medical Center; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"Yanamadala","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Virginia Mason Medical Center; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quinlan D.","family":"Buchlak","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Virginia Mason Medical Center; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv K.","family":"Sethi","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Virginia Mason Medical Center; and"},{"name":"Department of Health Services, University of Washington,Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg Spine","first-page":"92","article-title":"Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study","volume":"15","author":"Acosta FL","year":"2011","unstructured":"Acosta FL, Liu J, Slimack N, Moller D, Fessler R, Koski T: Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study. 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