Lateral Column Realignment Combined With Anterior Longitudinal Ligament Release Versus Three-Column Osteotomy in the Treatment of Thoracolumbar Kyphosis in Septuagenarians: A Retrospective Comparative Cohort Study.

Objective: Adult thoracolumbar kyphosis secondary to osteoporotic vertebral fractures (OVF) impairs the quality of life. Traditional 3CO provides correction but carries a high risk of complications, especially in the elderly. Minimally invasive anterior approaches may be safer. This study aims to compare the radiographic and clinical outcomes of septuagenarians with thoracolumbar kyphosis treated with single-position navigated lateral column realignment with anterior longitudinal ligament release (LCR-A) plus posterior column osteotomy (PCO) and posterior spinal fusion (PSF), or percutaneous pedicle screws (PPS) versus three-column osteotomy (3CO).

Materials and methods: This retrospective study included 21 patients with LCR-A and 54 with 3CO prospectively treated between March 2020 and April 2024. Radiographic parameters, the Oswestry Disability Index (ODI), SRS-22 scores, complications, and perioperative data were analyzed over a 2-year follow-up period.

Results: Although LCR-A patients were older, they had significantly reduced blood loss, shorter operative times, and fewer fused levels than 3CO patients. LCR-A achieved comparable deformity correction, with fewer complications, lower postoperative ODI, and better SRS-22 scores. The LCR-A group maintained radiographic correction, with fewer new neurological deficits and lower rates of infection, ileus, and delirium.

Conclusions: Single-position navigated LCR-A is a safer and less invasive alternative to 3CO in elderly patients with thoracolumbar kyphosis, offering effective deformity correction, fewer complications, improved functional outcomes, and enhanced recovery.

Level of evidence: IV.