The comprehensive anatomical spinal osteotomy and anterior column realignment classification: Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Juan S. Uribe, Frank Schwab, Gregory M. Mundis, David S. Xu, Jacob Januszewski, Adam S. Kanter, David O. Okonkwo, Serena S. Hu, Deviren Vedat, Robert Eastlack, Pedro Berjano, Praveen V. Mummaneni

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

© AANS 2018. OBJECTIVE Spinal osteotomies and anterior column realignment (ACR) are procedures that allow preservation or restoration of spine lordosis. Variations of these techniques enable different degrees of segmental, regional, and global sagittal realignment. The authors propose a comprehensive anatomical classification system for ACR and its variants based on the level of technical complexity and invasiveness. This serves as a common language and platform to standardize clinical and radiographic outcomes for the utilization of ACR. METHODS The proposed classification is based on 6 anatomical grades of ACR, including anterior longitudinal ligament (ALL) release, with varying degrees of posterior column release or osteotomies. Additionally, a surgical approach (anterior, lateral, or posterior) was added. Reliability of the classification was evaluated by an analysis of 16 clinical cases, rated twice by 14 different spine surgeons, and calculation of Fleiss kappa coefficients. RESULTS The 6 grades of ACR are as follows: grade A, ALL release with hyperlordotic cage, intact posterior elements; grade 1 (ACR + Schwab grade 1), additional resection of the inferior facet and joint capsule; grade 2 (ACR + Schwab grade 2), additional resection of both superior and inferior facets, interspinous ligament, ligamentum flavum, lamina, and spinous process; grade 3 (ACR + Schwab grade 3), additional adjacent-level 3-column osteotomy including pedicle subtraction osteotomy; grade 4 (ACR + Schwab grade 4), 2-level distal 3-column osteotomy including pedicle subtraction osteotomy and disc space resection; and grade 5 (ACR + Schwab grade 5), complete or partial removal of a vertebral body and both adjacent discs with or without posterior element resection. Intraobserver and interobserver reliability were 97% and 98%, respectively, across the 14-reviewer cohort. CONCLUSIONS The proposed anatomical realignment classification provides a consistent description of the various posterior and anterior column release/osteotomies. This reliability study confirmed that the classification is consistent and reproducible across a diverse group of spine surgeons.
Original languageEnglish
Pages (from-to)565-575
Number of pages11
JournalJournal of Neurosurgery: Spine
Volume29
Issue number5
DOIs
Publication statusPublished - Nov 1 2018

Fingerprint

Osteotomy
Peripheral Nerves
Spine
Joints
Longitudinal Ligaments
Ligamentum Flavum
Joint Capsule
Zygapophyseal Joint
Lordosis
Ligaments
Language

Keywords

  • LIF
  • Minimally invasive surgery
  • Osteotomy
  • Scoliosis
  • Spine deformity
  • Spine surgery
  • XLIF

Cite this

The comprehensive anatomical spinal osteotomy and anterior column realignment classification: Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves. / Uribe, Juan S.; Schwab, Frank; Mundis, Gregory M.; Xu, David S.; Januszewski, Jacob; Kanter, Adam S.; Okonkwo, David O.; Hu, Serena S.; Vedat, Deviren; Eastlack, Robert; Berjano, Pedro; Mummaneni, Praveen V.

In: Journal of Neurosurgery: Spine, Vol. 29, No. 5, 01.11.2018, p. 565-575.

Research output: Contribution to journalArticle

Uribe, JS, Schwab, F, Mundis, GM, Xu, DS, Januszewski, J, Kanter, AS, Okonkwo, DO, Hu, SS, Vedat, D, Eastlack, R, Berjano, P & Mummaneni, PV 2018, 'The comprehensive anatomical spinal osteotomy and anterior column realignment classification: Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves', Journal of Neurosurgery: Spine, vol. 29, no. 5, pp. 565-575. https://doi.org/10.3171/2018.4.SPINE171206
Uribe, Juan S. ; Schwab, Frank ; Mundis, Gregory M. ; Xu, David S. ; Januszewski, Jacob ; Kanter, Adam S. ; Okonkwo, David O. ; Hu, Serena S. ; Vedat, Deviren ; Eastlack, Robert ; Berjano, Pedro ; Mummaneni, Praveen V. / The comprehensive anatomical spinal osteotomy and anterior column realignment classification: Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves. In: Journal of Neurosurgery: Spine. 2018 ; Vol. 29, No. 5. pp. 565-575.
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AU - Xu, David S.

AU - Januszewski, Jacob

AU - Kanter, Adam S.

AU - Okonkwo, David O.

AU - Hu, Serena S.

AU - Vedat, Deviren

AU - Eastlack, Robert

AU - Berjano, Pedro

AU - Mummaneni, Praveen V.

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N2 - © AANS 2018. OBJECTIVE Spinal osteotomies and anterior column realignment (ACR) are procedures that allow preservation or restoration of spine lordosis. Variations of these techniques enable different degrees of segmental, regional, and global sagittal realignment. The authors propose a comprehensive anatomical classification system for ACR and its variants based on the level of technical complexity and invasiveness. This serves as a common language and platform to standardize clinical and radiographic outcomes for the utilization of ACR. METHODS The proposed classification is based on 6 anatomical grades of ACR, including anterior longitudinal ligament (ALL) release, with varying degrees of posterior column release or osteotomies. Additionally, a surgical approach (anterior, lateral, or posterior) was added. Reliability of the classification was evaluated by an analysis of 16 clinical cases, rated twice by 14 different spine surgeons, and calculation of Fleiss kappa coefficients. RESULTS The 6 grades of ACR are as follows: grade A, ALL release with hyperlordotic cage, intact posterior elements; grade 1 (ACR + Schwab grade 1), additional resection of the inferior facet and joint capsule; grade 2 (ACR + Schwab grade 2), additional resection of both superior and inferior facets, interspinous ligament, ligamentum flavum, lamina, and spinous process; grade 3 (ACR + Schwab grade 3), additional adjacent-level 3-column osteotomy including pedicle subtraction osteotomy; grade 4 (ACR + Schwab grade 4), 2-level distal 3-column osteotomy including pedicle subtraction osteotomy and disc space resection; and grade 5 (ACR + Schwab grade 5), complete or partial removal of a vertebral body and both adjacent discs with or without posterior element resection. Intraobserver and interobserver reliability were 97% and 98%, respectively, across the 14-reviewer cohort. CONCLUSIONS The proposed anatomical realignment classification provides a consistent description of the various posterior and anterior column release/osteotomies. This reliability study confirmed that the classification is consistent and reproducible across a diverse group of spine surgeons.

AB - © AANS 2018. OBJECTIVE Spinal osteotomies and anterior column realignment (ACR) are procedures that allow preservation or restoration of spine lordosis. Variations of these techniques enable different degrees of segmental, regional, and global sagittal realignment. The authors propose a comprehensive anatomical classification system for ACR and its variants based on the level of technical complexity and invasiveness. This serves as a common language and platform to standardize clinical and radiographic outcomes for the utilization of ACR. METHODS The proposed classification is based on 6 anatomical grades of ACR, including anterior longitudinal ligament (ALL) release, with varying degrees of posterior column release or osteotomies. Additionally, a surgical approach (anterior, lateral, or posterior) was added. Reliability of the classification was evaluated by an analysis of 16 clinical cases, rated twice by 14 different spine surgeons, and calculation of Fleiss kappa coefficients. RESULTS The 6 grades of ACR are as follows: grade A, ALL release with hyperlordotic cage, intact posterior elements; grade 1 (ACR + Schwab grade 1), additional resection of the inferior facet and joint capsule; grade 2 (ACR + Schwab grade 2), additional resection of both superior and inferior facets, interspinous ligament, ligamentum flavum, lamina, and spinous process; grade 3 (ACR + Schwab grade 3), additional adjacent-level 3-column osteotomy including pedicle subtraction osteotomy; grade 4 (ACR + Schwab grade 4), 2-level distal 3-column osteotomy including pedicle subtraction osteotomy and disc space resection; and grade 5 (ACR + Schwab grade 5), complete or partial removal of a vertebral body and both adjacent discs with or without posterior element resection. Intraobserver and interobserver reliability were 97% and 98%, respectively, across the 14-reviewer cohort. CONCLUSIONS The proposed anatomical realignment classification provides a consistent description of the various posterior and anterior column release/osteotomies. This reliability study confirmed that the classification is consistent and reproducible across a diverse group of spine surgeons.

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KW - Minimally invasive surgery

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KW - Scoliosis

KW - Spine deformity

KW - Spine surgery

KW - XLIF

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