Anterior Column Realignment Plus Smith-Petersen Osteotomy Versus Smith-Petersen Osteotomy-Only for Adult Spinal...

Area of Science:

• Spine surgery
• Orthopedic surgery
• Adult spinal deformity

Background:

• Anterior column realignment (ACR) aims to increase lordosis via ligament release and hyperlordotic cages.
• The added benefit of ACR with Smith-Petersen osteotomy (SPO) in thoracolumbar adult spinal deformity (ASD) requires further investigation.

Purpose of the Study:

• To compare the clinical and radiographic outcomes of ACR combined with SPO versus SPO-only in thoracolumbar ASD reconstruction.

Main Methods:

• Retrospective cohort study of 66 adult patients with thoracolumbar ASD undergoing multilevel fusion with pelvic fixation.
• Patients were grouped into ACR + SPO (n=27) or SPO-only (n=39) based on surgical technique.
• Primary outcomes included Oswestry Disability Index and Visual Analogue Scale (VAS) scores for axial and radicular pain at ≥6-month follow-up.

Main Results:

• Both groups showed clinically meaningful improvements in Oswestry Disability Index and radicular VAS scores without significant between-group differences.
• Lumbar lordosis correction per interbody level was similar (5.7° vs 5.4°).
• ACR + SPO was associated with a significantly longer hospital stay (P=.003) and worse residual axial pain (VAS mean difference 1.0; P=.009).

Conclusions:

• In thoracolumbar ASD reconstruction, ACR did not offer superior sagittal alignment correction or functional improvement over SPO-only.
• ACR increased hospitalization duration and was linked to poorer outcomes for residual axial pain.
• The findings support a selective, indication-driven approach for using ACR in these complex spinal reconstructions.