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Updated: May 9, 2026
Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
Published on: September 16, 2022
Oblique Anterior Column Realignment for Minimally Invasive Adult Spinal Deformity Correction: An Illustrative Case
Misa Trieu1, Nolan J Brown2,3, Timothy Y Kim4
1Cooper Medical School of Rowan University, Camden, New Jersey, USA.
Background And Objectives:
Adult spinal deformity (ASD) leads to pain, disability, and reduced quality of life. Traditional multilevel posterior osteotomies are associated with complication rates up to 78%. Anterior column realignment (ACR) through an oblique minimally invasive surgery (MIS) approach offers direct visualization of the anterior longitudinal ligament, reducing motor injury risk. This study evaluates the safety and efficacy of this technique through illustrative case series, systematic review, and meta-analysis.
Methods:
A single-center retrospective case series presents 3 patients with class III ASD undergoing oblique ACR with robot-assisted posterior fixation. PubMed, Embase, and Cochrane were searched (July 25, 2025) for studies on MIS oblique ACR for ASD. Studies lacking sagittal imbalance or complete clinical data were excluded. Three studies met inclusion criteria and passed Joanna Briggs Institute critical appraisal.
Results:
In the case series, sagittal alignment improved: mean sagittal vertical axis decreased from 11.1 to 3.7 cm, lumbar lordosis increased from 12.7° to 61.0°, and pelvic incidence-lumbar lordosis decreased from 50.3° to 4.7°. Postoperative L1-pelvic angle improved to within 6° of each patient's ideal, highlighting correction toward contemporary targets. Functional gains were notable, no complications occurred, and improvements persisted at 6 to 24 months. The systematic review corroborated low complication rates and effective correction with pooled vessel injury rate of 1.6% (95% CI, 0%-3.8%) and no proximal junctional failure. Across 124 patients and 222 segments, pooled disc angle correction was 11.53° (95% CI, 10.73-12.33), pooled fusion rate was 95.4% (95% CI, 91.7%-99.0%), and pooled complication rate was 21.9% (95% CI, 12.0%-36.6%).
Conclusion:
Oblique ACR is an emerging MIS strategy for ASD, providing robust spinal realignment. Our findings suggest that this advanced technique may be considered in medically and radiographically complex patients. Future studies are needed to evaluate long-term durability and comparative effectiveness vs alternative MIS or open techniques.
