前柱矫正术（ACR）的影像学结果和并发症：系统回顾。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal Pub Date : 2024-12-01 DOI:10.1016/j.spinee.2024.08.003

Gregory M. Mundis Jr MD , Hazem Elsebaie MD , Bahar Shahidi DPT, PhD , Isaiah Love BS , Pearce B. Haldeman BS , Robert K. Eastlack MD , Behrooz A. Akbarnia MD

{"title":"前柱矫正术（ACR）的影像学结果和并发症：系统回顾。","authors":"Gregory M. Mundis Jr MD , Hazem Elsebaie MD , Bahar Shahidi DPT, PhD , Isaiah Love BS , Pearce B. Haldeman BS , Robert K. Eastlack MD , Behrooz A. Akbarnia MD","doi":"10.1016/j.spinee.2024.08.003","DOIUrl":null,"url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Anterior Column Realignment (ACR) was introduced to serve as a powerful segmental kyphosis correction technique in minimally invasive Adult Spinal Deformity (ASD) surgery. Releasing the Anterior Longitudinal Ligament (ALL) and annulus allows opening of the disc space to accommodate hyperlordotic cages. The overall safety and efficacy of ACR has been difficult to determine due to the heterogenicity of surgical techniques, complications reporting, and a paucity of published studies leading to preliminary and controversial conclusions.</div></div><div><h3>PURPOSE</h3><div>To determine the efficacy and complications rates associated with ACR.</div></div><div><h3>STUDY DESIGN</h3><div>Systematic review.</div></div><div><h3>METHODS</h3><div>We queried the MEDLINE, Google Scholar, and EMBASE databases for all literature related to ACR procedure with a publication cutoff start date of January 1, 2010. This systematic review was performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. nonEnglish, nonhuman, case reports and review article publications were excluded.</div></div><div><h3>RESULTS</h3><div>A total of 298 studies were identified. Following screening of title, abstract, and full text, 16 articles were included in the review with a total 756 patients. All the studies included in this systematic review were retrospective case series with a level of evidence IV. Ten studies reported ACR-related complications, with an average rate of 27.2%. The rate of reoperations was reported in 5 studies, for which the average reoperation rate was 9.5%. Cage Subsidence (CS) occurred in 13.7%, Proximal Junctional Kyphosis (PJK) in 12.2%, neurologic injury in 7.3%, and Proximal Junctional Failure (PJF) in 2.7%. The vascular injury rate was 0.5%, with bowel perforation and ureteric injury occurring in 0.2%. For the Patient Reported Outcome Measures (PROMs) and radiological outcome analysis we excluded studies with less than 12 months follow up leaving 8 studies eligible for the analysis. There was a significant improvement of both local Motion Segment Angle (MSA) and Intra Discal Angle (IDA) with a mean segmental correction of 20° lordosis in the 3 studies that reported these parameters.</div></div><div><h3>CONCLUSION</h3><div>Based on the limited data available in this systematic review, the ACR technique has significant ability to restore and, when needed, correct the local segmental intervertebral angulation and thereby influencing the overall regional and global sagittal alignment. The associated risk of vascular, bowel, and nerve injury did not seem to be significantly higher in this review than other alternative lumbar interbody fusion techniques. Additional higher quality studies, including a consensus for reporting complications is required to reach definitive conclusions regarding its possible associated risks.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"24 12","pages":"Pages 2273-2284"},"PeriodicalIF":4.9000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Radiographic outcomes and complications of anterior column realignment (ACR): a systematic review\",\"authors\":\"Gregory M. Mundis Jr MD , Hazem Elsebaie MD , Bahar Shahidi DPT, PhD , Isaiah Love BS , Pearce B. Haldeman BS , Robert K. Eastlack MD , Behrooz A. Akbarnia MD\",\"doi\":\"10.1016/j.spinee.2024.08.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>BACKGROUND</h3><div>Anterior Column Realignment (ACR) was introduced to serve as a powerful segmental kyphosis correction technique in minimally invasive Adult Spinal Deformity (ASD) surgery. Releasing the Anterior Longitudinal Ligament (ALL) and annulus allows opening of the disc space to accommodate hyperlordotic cages. The overall safety and efficacy of ACR has been difficult to determine due to the heterogenicity of surgical techniques, complications reporting, and a paucity of published studies leading to preliminary and controversial conclusions.</div></div><div><h3>PURPOSE</h3><div>To determine the efficacy and complications rates associated with ACR.</div></div><div><h3>STUDY DESIGN</h3><div>Systematic review.</div></div><div><h3>METHODS</h3><div>We queried the MEDLINE, Google Scholar, and EMBASE databases for all literature related to ACR procedure with a publication cutoff start date of January 1, 2010. This systematic review was performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. nonEnglish, nonhuman, case reports and review article publications were excluded.</div></div><div><h3>RESULTS</h3><div>A total of 298 studies were identified. Following screening of title, abstract, and full text, 16 articles were included in the review with a total 756 patients. All the studies included in this systematic review were retrospective case series with a level of evidence IV. Ten studies reported ACR-related complications, with an average rate of 27.2%. The rate of reoperations was reported in 5 studies, for which the average reoperation rate was 9.5%. Cage Subsidence (CS) occurred in 13.7%, Proximal Junctional Kyphosis (PJK) in 12.2%, neurologic injury in 7.3%, and Proximal Junctional Failure (PJF) in 2.7%. The vascular injury rate was 0.5%, with bowel perforation and ureteric injury occurring in 0.2%. For the Patient Reported Outcome Measures (PROMs) and radiological outcome analysis we excluded studies with less than 12 months follow up leaving 8 studies eligible for the analysis. There was a significant improvement of both local Motion Segment Angle (MSA) and Intra Discal Angle (IDA) with a mean segmental correction of 20° lordosis in the 3 studies that reported these parameters.</div></div><div><h3>CONCLUSION</h3><div>Based on the limited data available in this systematic review, the ACR technique has significant ability to restore and, when needed, correct the local segmental intervertebral angulation and thereby influencing the overall regional and global sagittal alignment. The associated risk of vascular, bowel, and nerve injury did not seem to be significantly higher in this review than other alternative lumbar interbody fusion techniques. Additional higher quality studies, including a consensus for reporting complications is required to reach definitive conclusions regarding its possible associated risks.</div></div>\",\"PeriodicalId\":49484,\"journal\":{\"name\":\"Spine Journal\",\"volume\":\"24 12\",\"pages\":\"Pages 2273-2284\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1529943024009264\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1529943024009264","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

摘要

背景：在微创成人脊柱畸形（ASD）手术中，前柱复位（ACR）是一种强有力的节段性脊柱后凸矫正技术。松解前纵韧带（ALL）和椎环可打开椎间盘间隙，以容纳过大的脊柱保持架。由于手术技术和并发症报告的不一致性，以及发表的研究较少，导致得出的初步结论存在争议，因此 ACR 的整体安全性和有效性一直难以确定。研究目的：确定与 ACR 相关的有效性和并发症发生率：研究设计：系统回顾方法：：我们在 MEDLINE、Google Scholar 和 EMBASE 数据库中查询了所有与 ACR 程序相关的文献，其发表截止日期为 2010 年 1 月 1 日。本系统综述采用系统综述和元分析首选报告项目（PRISMA）指南进行。排除了非英语、非人类、病例报告和评论文章等出版物：结果：共确定了 298 项研究。经过对标题、摘要和全文的筛选，有 16 篇文章被纳入研究，共纳入 756 名患者。本系统综述纳入的所有研究均为回顾性病例系列，证据等级为 IV 级。十项研究报告了 ACR 相关并发症，平均发生率为 27.2%。5项研究报告了再手术率，平均再手术率为9.5%。13.7%的患者发生了支架下沉（CS），12.2%的患者发生了近端交界处后凸，7.3%的患者发生了神经损伤，2.7%的患者发生了近端交界处功能衰竭（PJF）。血管损伤发生率为 0.5%，肠穿孔和输尿管损伤发生率为 0.2%。对于患者报告结果指标（PROMs）和放射学结果分析，我们排除了随访时间少于 12 个月的研究，剩下 8 项研究符合分析条件。在报告了这些参数的 3 项研究中，局部运动节段角度（MSA）和椎间盘内角度（IDA）均有明显改善，平均节段矫正前凸 20°：根据本系统综述中的有限数据，ACR 技术在恢复和必要时矫正局部节段椎间角度方面具有显著能力，从而影响整体区域和整体矢状对齐。在本综述中，血管、肠道和神经损伤的相关风险似乎并没有明显高于其他替代性腰椎椎间融合技术。要就其可能存在的相关风险得出明确结论，还需要进行更多高质量的研究，包括就并发症的报告达成共识。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Radiographic outcomes and complications of anterior column realignment (ACR): a systematic review

BACKGROUND

Anterior Column Realignment (ACR) was introduced to serve as a powerful segmental kyphosis correction technique in minimally invasive Adult Spinal Deformity (ASD) surgery. Releasing the Anterior Longitudinal Ligament (ALL) and annulus allows opening of the disc space to accommodate hyperlordotic cages. The overall safety and efficacy of ACR has been difficult to determine due to the heterogenicity of surgical techniques, complications reporting, and a paucity of published studies leading to preliminary and controversial conclusions.

PURPOSE

To determine the efficacy and complications rates associated with ACR.

STUDY DESIGN

Systematic review.

METHODS

We queried the MEDLINE, Google Scholar, and EMBASE databases for all literature related to ACR procedure with a publication cutoff start date of January 1, 2010. This systematic review was performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. nonEnglish, nonhuman, case reports and review article publications were excluded.

RESULTS

A total of 298 studies were identified. Following screening of title, abstract, and full text, 16 articles were included in the review with a total 756 patients. All the studies included in this systematic review were retrospective case series with a level of evidence IV. Ten studies reported ACR-related complications, with an average rate of 27.2%. The rate of reoperations was reported in 5 studies, for which the average reoperation rate was 9.5%. Cage Subsidence (CS) occurred in 13.7%, Proximal Junctional Kyphosis (PJK) in 12.2%, neurologic injury in 7.3%, and Proximal Junctional Failure (PJF) in 2.7%. The vascular injury rate was 0.5%, with bowel perforation and ureteric injury occurring in 0.2%. For the Patient Reported Outcome Measures (PROMs) and radiological outcome analysis we excluded studies with less than 12 months follow up leaving 8 studies eligible for the analysis. There was a significant improvement of both local Motion Segment Angle (MSA) and Intra Discal Angle (IDA) with a mean segmental correction of 20° lordosis in the 3 studies that reported these parameters.

CONCLUSION

Based on the limited data available in this systematic review, the ACR technique has significant ability to restore and, when needed, correct the local segmental intervertebral angulation and thereby influencing the overall regional and global sagittal alignment. The associated risk of vascular, bowel, and nerve injury did not seem to be significantly higher in this review than other alternative lumbar interbody fusion techniques. Additional higher quality studies, including a consensus for reporting complications is required to reach definitive conclusions regarding its possible associated risks.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Spine Journal 医学-临床神经学

CiteScore

8.20

自引率

6.70%

发文量

680

审稿时长

13.1 weeks

期刊介绍： The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.