Anterior cement augmentation technique for correction of kyphotic deformity in the lumbar spine using an anterior-to-Psoas approach.

Abstract

BackgroundPosterior kyphotic deformity correction in patients with osteoporosis carries a significant risk of instrumentation cut-out. Anterior approaches allow direct distraction at the center of the deformity, yet reduction devices or instrumentation may telescope into vertebral endplates. This study proposes an anterior cementing augmentation technique for correction of kyphotic deformity involving a less invasive oblique lateral interbody fusion (OLIF) approach.Case descriptionPatient 1 had a previous compression fracture at L2 above prior instrumented fusion, with kyphotic deformity, and underwent a stage-one anterior lateral L2 corpectomy via an (OLIF) approach. Cement was placed centrally at L1 and L3, followed by an expandable cage and a stage-two posterior T11-to-pelvis instrumented fusion with prophylactic cement augmentation at T10-T12. Patient 2 had a previous remote L5-S1 anterior lumbar interbody fusion and underwent a posterior C4-S1 osteotomy and instrumented fusion for kyphoscoliosis deformity. The patient developed immediate postoperative instrumentation failure with kyphosis at L4-L5 and instrumentation loosening and migration at L4-S1 within 2 weeks of surgery. They then underwent (OLIF) at L4-L5 with anterior cement augmentation at L4-L5, followed by a revision lumbar-pelvic instrumented fusion.OutcomeA step-by-step technique was described for anterior corpectomy and cement augmentation via an anterior lateral approach, presenting an alternative for correction of kyphotic deformity and restoration of sagittal alignment in the lumbar spine of patients with poor-bone density.ConclusionsA minimally invasive, anterior-to- psoas approach may decrease morbidity of approach related complications. Both patients demonstrated kyphotic deformity correction with follow-up records suggesting favorable outcomes.