{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T01:53:43Z","timestamp":1782352423294,"version":"3.54.5"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"11","license":[{"start":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T00:00:00Z","timestamp":1710115200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Adult spinal deformity (ASD) occurs from progressive anterior column collapse due to disc space desiccation, compression fractures, and autofusion across disc spaces. Anterior column realignment (ACR) is increasingly recognized as a powerful tool to address ASD by progressively lengthening the anterior column through the release of the anterior longitudinal ligament during lateral interbody approaches. Here, we describe the application of minimally invasive ACR through an oblique antepsoas corridor for deformity correction in a patient with adult degenerative scoliosis and significant sagittal imbalance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 65-year-old female with a prior history of L4\u20135 transforaminal lumbar interbody fusion and morbid obesity presented with refractory, severe low-back and lower-extremity pain. Preoperative radiographs showed significant sagittal imbalance. Computed tomography showed a healed L4\u20135 fusion and a vacuum disc at L3\u20134 and L5\u2013S1, whereas magnetic resonance imaging was notable for central canal stenosis at L3\u20134. The patient was treated with a first-stage L5\u2013S1 lateral anterior lumbar interbody fusion with oblique L2\u20134 ACR. The second-stage posterior approach consisted of a robot-guided minimally invasive T10\u2013ilium posterior instrumented fusion with a mini-open L2\u20134 posterior column osteotomy (PCO). Postoperative radiographs showed the restoration of her sagittal balance. There were no complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Oblique ACR is a powerful minimally invasive tool for sagittal plane correction. When combined with a mini-open PCO, substantial segmental lordosis can be achieved while eliminating the need for multilevel PCO or invasive three-column osteotomies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23680","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T13:00:52Z","timestamp":1710162052000},"source":"Crossref","is-referenced-by-count":4,"title":["Oblique anterior column realignment with a mini-open posterior column osteotomy for minimally invasive adult spinal deformity correction: illustrative case"],"prefix":"10.3171","volume":"7","author":[{"given":"Zach","family":"Pennington","sequence":"first","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nolan J","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California-Irvine, Orange, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyedamirhossein","family":"Pishva","sequence":"additional","affiliation":[{"name":"Kansas City University College of Medicine, Kansas City, Missouri; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hern\u00e1n F. J","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin H","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"J Neurosurg Spine","first-page":"160","article-title":"Surgical treatment of pathological loss of lumbar lordosis (flatback) in patients with normal sagittal vertical axis achieves similar clinical improvement as surgical treatment of elevated sagittal vertical axis: clinical article","volume":"21","author":"Smith JS","year":"2014","unstructured":"Smith JS, Singh M, Klineberg E,  Surgical treatment of pathological loss of lumbar lordosis (flatback) in patients with normal sagittal vertical axis achieves similar clinical improvement as surgical treatment of elevated sagittal vertical axis: clinical article. J Neurosurg Spine. 2014;21(2):160\u2013170."},{"key":"b2","series-title":"Handbook of Spine Surgery","year":"2016","unstructured":"Baaj AA, Mummaneni PV, Uribe JS, Vaccaro AR, Greenberg MS, eds. Handbook of Spine Surgery. Georg Thieme Verlag; 2016."},{"issue":"5","key":"b3","series-title":"J Neurosurg Spine","first-page":"741","article-title":"The minimally invasive interbody selection algorithm for spinal deformity","volume":"34","author":"Mummaneni PV","year":"2021","unstructured":"Mummaneni PV, Hussain I, Shaffrey CI,  The minimally invasive interbody selection algorithm for spinal deformity. J Neurosurg Spine. 2021;34(5):741\u2013748."},{"issue":"5","key":"b4","series-title":"Neurosurg Focus","first-page":"E6","article-title":"The minimally invasive spinal deformity surgery algorithm: a reproducible rational framework for decision making in minimally invasive spinal deformity surgery","volume":"36","author":"Mummaneni PV","year":"2014","unstructured":"Mummaneni PV, Shaffrey CI, Lenke LG,  The minimally invasive spinal deformity surgery algorithm: a reproducible rational framework for decision making in minimally invasive spinal deformity surgery. Neurosurg Focus. 2014;36(5):E6."},{"issue":"9","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"1082","article-title":"Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population","volume":"30","author":"Schwab F","year":"2005","unstructured":"Schwab F, Dubey A, Gamez L,  Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976). 2005;30(9):1082\u20131085."},{"issue":"3","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"224","article-title":"The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases","volume":"41","author":"Bess S","year":"2016","unstructured":"Bess S, Line B, Fu KM,  The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases. Spine (Phila Pa 1976). 2016;41(3):224\u2013233."},{"issue":"10193","key":"b7","series-title":"Lancet","first-page":"160","article-title":"Adult spinal deformity","volume":"394","author":"Diebo BG","year":"2019","unstructured":"Diebo BG, Shah NV, Boachie-Adjei O,  Adult spinal deformity. Lancet. 2019;394(10193):160\u2013172."},{"issue":"2","key":"b8","series-title":"Global Spine J","first-page":"101S","article-title":"Minimally invasive anterior longitudinal ligament release for anterior column realignment","volume":"10","author":"Godzik J","year":"2020","unstructured":"Godzik J, Pereira BA, Hemphill C,  Minimally invasive anterior longitudinal ligament release for anterior column realignment. Global Spine J. 2020;10(2 suppl):101S-110S."},{"key":"b9","series-title":"World Neurosurg","first-page":"e92","article-title":"Characterizing the current clinical trial landscape in spinal deformity: A retrospective analysis of trends in the Clinicaltrials.gov registry","volume":"174","author":"Chen JW","year":"2023","unstructured":"Chen JW, Martini M, Pennington Z,  Characterizing the current clinical trial landscape in spinal deformity: A retrospective analysis of trends in the Clinicaltrials.gov registry. World Neurosurg. 2023;174:e92-e102."},{"issue":"10","key":"b10","series-title":"J Neurosurg Case Lessons","first-page":"CASE22520","article-title":"Robotics planning in minimally invasive surgery for adult degenerative scoliosis: illustrative case","volume":"5","author":"Pennington Z","year":"2023","unstructured":"Pennington Z, Brown NJ, Quadri S, Pishva S, Kuo CC, Pham MH Robotics planning in minimally invasive surgery for adult degenerative scoliosis: illustrative case. J Neurosurg Case Lessons. 2023;5(10):CASE22520."},{"issue":"6","key":"b11","series-title":"J Neurosurg Spine","first-page":"530","article-title":"Anterior longitudinal ligament release using the minimally invasive lateral retroperitoneal transpsoas approach: a cadaveric feasibility study and report of 4 clinical cases","volume":"17","author":"Deukmedjian AR","year":"2012","unstructured":"Deukmedjian AR, Le TV, Baaj AA, Dakwar E, Smith DA, Uribe JS Anterior longitudinal ligament release using the minimally invasive lateral retroperitoneal transpsoas approach: a cadaveric feasibility study and report of 4 clinical cases. 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Neurosurg Focus Video. 2022;7(1):V7."},{"key":"b17","series-title":"World Neurosurg","first-page":"e1","article-title":"Radiographic outcomes following ACDF with hyperlordotic implants to achieve cervical anterior column realignment","volume":"174","author":"Shahrestani S","year":"2023","unstructured":"Shahrestani S, Ton A, Brown NJ,  Radiographic outcomes following ACDF with hyperlordotic implants to achieve cervical anterior column realignment. 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J Am Acad Orthop Surg. 2024;32(1): e33\u2013e43."},{"issue":"2","key":"b26","series-title":"J Neurosurg Spine","first-page":"1","article-title":"Patient outcomes after circumferential minimally invasive surgery compared with those of open correction for adult spinal deformity: initial analysis of prospectively collected data","volume":"36","author":"Chou D","year":"2021","unstructured":"Chou D, Lafage V, Chan AY,  Patient outcomes after circumferential minimally invasive surgery compared with those of open correction for adult spinal deformity: initial analysis of prospectively collected data. J Neurosurg Spine. 2021;36(2):1\u201312."},{"issue":"3","key":"b27","series-title":"Spine J","first-page":"465","article-title":"Optimizing biomechanics of anterior column realignment for minimally invasive deformity correction","volume":"20","author":"Godzik J","year":"2020","unstructured":"Godzik J, Pereira BA, Newcomb AGUS,  Optimizing biomechanics of anterior column realignment for minimally invasive deformity correction. Spine J. 2020;20(3):465\u2013474."},{"issue":"4","key":"b28","series-title":"J Neurosurg Spine","first-page":"595","article-title":"Two- and three-year outcomes of minimally invasive and hybrid correction of adult spinal deformity","volume":"36","author":"Chan AK","year":"2021","unstructured":"Chan AK, Eastlack RK, Fessler RG,  Two- and three-year outcomes of minimally invasive and hybrid correction of adult spinal deformity. 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Global Spine J. 2020;10(2 suppl):101S-110S."},{"key":"b9","series-title":"World Neurosurg","first-page":"e92","article-title":"Characterizing the current clinical trial landscape in spinal deformity: A retrospective analysis of trends in the Clinicaltrials.gov registry","volume":"174","author":"Chen JW","year":"2023","unstructured":"Chen JW, Martini M, Pennington Z,  Characterizing the current clinical trial landscape in spinal deformity: A retrospective analysis of trends in the Clinicaltrials.gov registry. World Neurosurg. 2023;174:e92-e102."},{"issue":"10","key":"b10","series-title":"J Neurosurg Case Lessons","first-page":"CASE22520","article-title":"Robotics planning in minimally invasive surgery for adult degenerative scoliosis: illustrative case","volume":"5","author":"Pennington Z","year":"2023","unstructured":"Pennington Z, Brown NJ, Quadri S, Pishva S, Kuo CC, Pham MH Robotics planning in minimally invasive surgery for adult degenerative scoliosis: illustrative case. 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Neurosurg Focus Video. 2022;7(1):V7."},{"key":"b17","series-title":"World Neurosurg","first-page":"e1","article-title":"Radiographic outcomes following ACDF with hyperlordotic implants to achieve cervical anterior column realignment","volume":"174","author":"Shahrestani S","year":"2023","unstructured":"Shahrestani S, Ton A, Brown NJ,  Radiographic outcomes following ACDF with hyperlordotic implants to achieve cervical anterior column realignment. World Neurosurg. 2023;174:e1\u2013e7."},{"key":"b18","series-title":"World Neurosurg","first-page":"e600","article-title":"External validation of the Global Alignment and Proportion score as prognostic tool for corrective surgery in adult spinal deformity: A systematic review and meta-analysis","volume":"177","author":"Gendreau JL","year":"2023","unstructured":"Gendreau JL, Nguyen A, Brown NJ,  External validation of the Global Alignment and Proportion score as prognostic tool for corrective surgery in adult spinal deformity: A systematic review and meta-analysis. 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