Revision thoracolumbar surgery for flat back deformity: staged ALIF & poste column osteotomies...
Three-column osteotomies (3COs) can achieve significant alignment correction when revising fixed sagittal plane deformities; however, the technique is associated with high complication rates. The authors demonstrate staged anterior-posterior surgery with L5–S1 ALIF (below a prior L3–5 fusion) and multilevel Smith-Petersen osteotomies to circumvent the morbidity associated with 3CO. The patient was a 67-year-old male with three prior lumbar surgeries who presented with back and leg pain. Imaging demonstrated lumbar flat back deformity and sagittal imbalance. The narrated video details key radiological measurements, operative planning and rationale, surgical steps, and outcomes. The patient provided written, informed consent for publication of this illustrative case. Alexandria C. Marino, MD, PhD,1 Thomas J. Buell, MD,1 Rebecca M. Burke, MD, PhD,1 Tony R. Wang, MD,1 Chun-Po Yen, MD,1 Christopher I. Shaffrey, MD,2 and Justin S. Smith, MD, PhD1 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and 2Departments of Neurosurgery and Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina