Anterior Column Release: With Great Lordosis Comes Great Risk of Complications-A Case Series.

Study design: Retrospective review.

Objective: We sought to characterize complications associated with anterior column release (ACR).

Summary of background data: Correction of positive sagittal imbalance was traditionally completed with anterior column grafts or posterior osteotomies. ACR is a minimally invasive technique for addressing sagittal plane deformity by restoring lumbar lordosis.

Methods: We conducted a retrospective review of consecutive patients who underwent ACR in a prospectively kept database at a tertiary care academic center from January 2012 to December 2018. The prespecified complications were hardware failure (rod fracture, hardware loosening, or screw fracture), proximal junctional kyphosis, ipsilateral thigh numbness, ipsilateral femoral nerve weakness, arterial injury requiring blood transfusion, bowel injury, and abdominal pseudohernia.

Results: Thirty-eight patients were identified. Thirty-five patients had ACR at L3-4, 1 had ACR at L4-5, and 1 patient had ACR at L2-3 and L3-4. Eighteen patients (47.4%) had one of the prespecified complications (10 patients had multiple). Ten patients developed hardware failure (26.3%); 8 patients (21.1%) had rod fracture, 4 (10.5%) had screw fracture, and 1 (2.6%) had screw loosening. At discharge, rates of ipsilateral thigh numbness (37.8%) and hip flexor (37.8%)/quadriceps weakness (29.7%) were the highest. At follow-up, 6 patients (16.2%) had ipsilateral anterolateral thigh numbness, 5 (13.5%) suffered from ipsilateral hip flexion weakness, and 3 patients (5.4%) from ipsilateral quadriceps weakness. Arterial injury occurred in 1 patient (2.7%). Abdominal pseudohernia occurred in 1 patient (2.7%). There were no bowel injuries observed.

Conclusions: ACR is associated with a higher than initially anticipated risk of neurological complications, hardware failure, and proximal junctional kyphosis.