Background:

Correction surgery for rigid adult spinal deformity usually involves a complex 360° osteotomy, multiple intraoperative repositioning, and staged surgery. Moreover, there is a lack of consensus regarding the surgical strategy for this pathology. Here, we report the technical advantages of a simultaneous anterior and posterior release only in the lateral decubitus position to reduce surgical invasiveness in two case reports.

Case presentation:

A 76-year-old woman and an 80-year-old woman had a significant spinal imbalance and segmental fusion in the anterior and posterior columns around the apex of the lumbar spinal coverture. We conducted this procedure for these patients at the first stage of spinal corrective surgery to achieve 360° osteotomy. A long posterior fusion surgery was performed after one week. The mean value of the central sacral vertical line (CSVL), pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), and pelvic tilt (PT) improved drastically postoperatively (CSVL 51.0 to 7.5 mm, PI-LL 27.5° to 0.5°, SVA 107.6 to 14 mm, and PT 34.0° to 13.0°). The mean surgical time and blood loss in the first- and second-stage operations were 242.1 min and 702 mL and 315.5 min and 549 mL, respectively, and no perioperative complications occurred. This simultaneous 360° segmental release in the lateral decubitus position without repositioning can make it possible to acquire satisfactory correction and reduce surgical invasiveness compared with the conventional procedure.

Conclusion:

Simultaneous release in the lateral decubitus position without repositioning is a feasible, effective, and safe procedure for the treatment of a rigid adult spinal deformity.