Anterior longitudinal ligament release from a posterior approach: an alternative to three-column osteotomy

Nathan Han, Nathan Pratt, M. Farooq Usmani, Erik Hayman, Salazar Jones, Parker Johnsen, Alexandra E. Thomson, Ivan Ye, Timothy Chryssikos, Ashish Sharma, Joshua Olexa, Daniel L. Cavanaugh, Eugene Y. Koh, Kendall Buraimoh, Steven Ludwig, Charles Sansur

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: Expansion of the anterior column and compression of the posterior column restores lordosis and sagittal imbalance. Anterior longitudinal ligament (ALL) release has been described from lateral and anterior approaches as a technique to improve lumbar lordosis; however, posterior approach to release the ALL has not been adequately assessed. Methods: We demonstrate a case series of ALL release using a posterior approach performed in conjunction with posterior column osteotomy (PCO), with or without transforaminal lumbar interbody fusion (TLIF) for spinal deformity. Eleven cases were identified from billing records between 2010 and 2019. Retrospective review was conducted for perioperative complications and revision surgery. Overall and segmental lumbar lordosis (LL) correction was measured from pre- and postoperative imaging. Results: Eleven patients underwent ALL release with a PCO. Kyphosis, scoliosis, and flat back syndrome were the most common spinal deformities. On average, patients had 9 ± 3 levels fused and a single level ALL release. ALL release was most commonly performed at L1-L2 and L2-L3 levels. An overall LL correction of 28.6° ± 19.8o was achieved; ALL release introduced 16.7° ± 11.9° of lordotic correction and accounted for 49.2 ± 30.4% of the overall lordotic correction. Average blood loss was 1030 ± 573 mL. Conclusions: ALL release as an adjunct to PCO and TLIF is a viable technique for providing increased deformity correction without subjecting the patient to a more invasive three-column osteotomy. While this approach may not be appropriate for all patients, it represents a useful option in spinal deformity correction while limiting blood loss and additional anterior surgery.

Original languageEnglish (US)
Pages (from-to)2196-2203
Number of pages8
JournalEuropean Spine Journal
Issue number9
StatePublished - Sep 2022
Externally publishedYes


  • Anterior Longitudinal Ligament (ALL)
  • Lumbar Lordosis (LL)
  • Posterior Column Osteotomy (PCO)
  • Sagittal alignment
  • Three-column osteotomy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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