One of the most fearsome problems of correction surgery of vertebral deformities is mechanical complication.
The broken of the rods represent one of the most common mechanical failure.
It can be due to inadequate correction of the deformity, non-union, fatigue of the rods or lack of adequate anterior column support.
The patient in the pictures presented complaining for severe back pain a few months after surgery for deformity correction with thoraco-pelvis fusion.
At the time of presentation, she showed a sagittal and coronal imbalance with walking impairment.
The standard radiographs showed bilaterally broken rods with worsening of the deformity on the sagittal and coronal plane.
Surgery was suggested with the aim to solve the mechanical failure and to restore a proper spinal alignment.
The technique of anterior interbody fusion with a hyperlordotic cage, through a lateral trans-psoas approach consists in the placement of a cage between two vertebral bodies where the breaking of the rods was evident, in order to obtain an adequate anterior column support and to correct the lack of lumbar lordosis – the release of the anterior longitudinal ligament is mandatory to obtain a proper anterior column realignment.
Posterior revision of the instrumentation was needed.
Locally harvested autologous bone is placed in order to obtain fusion.
After the surgery, a proper balance of the spine was obtained. Years after the operation, the patient was pain free and without the occurrence of other mechanical complication and with a good fusion of the spine.
The Anterior Column Realignment (ACR) is an emerging, less invasive technique for correction of sagittal deformity with similar restorative capacity as other techniques with same or lower complication rates.
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