Evidence map›Paper›PMID 42788111›Full record

ArticleNeurosurgery practice2026

Posterior Intradiscal Osteotomy With Posterior Approach Anterior Column Release at L5-S1 for Rigid Flat Back Deformity: A Single-Approach Alternative to ALIF or PSO for Sagittal Balance Restoration.

Mohsen Rostami, Diego Soto Rubio, Sadegh Bagherzadeh, Negin Safari Dehnavi, Anjali Pradhan, Priyanka Pradhan, Katherine Elizabeth Baker, Sawyer Bauer, Joshua Vignolles-Jeong, Natalie Jun Bales and 2 more

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Article in Neurosurgery practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

12 authors.

Mohsen RostamiDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.ORCID https://orcid.org/0000-0003-1296-9751
Diego Soto RubioDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Sadegh BagherzadehDepartment of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Negin Safari DehnaviDepartment of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Anjali PradhanDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Priyanka PradhanDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Katherine Elizabeth BakerDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Sawyer BauerDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Joshua Vignolles-JeongDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Natalie Jun BalesDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Erik HaymanDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Puya AlikhaniDepartment of Neurosurgery, Brain and Spine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and importanceRestoring distal lumbar lordosis at a fused L5-S1 junction is challenging in adult spinal deformity surgery, particularly in revision cases with limited anterior access. Posterior intradiscal osteotomy (IDO) with posterior approach anterior column release (P-ACR) provides a single-posterior approach for mobilizing the anterior column and restoring distal lumbar lordosis without the risks of retroperitoneal exposure. This report details the operative nuances and technical sequence for L5-S1 IDO with P-ACR and summarizes early outcomes from complex revision cases. CLINICAL PRESENTATION: Four patients with rigid sagittal imbalance, prior multilevel lumbar surgery, and near-complete L5-S1 autofusion underwent L5-S1 IDO with P-ACR. Three patients were nonambulatory preoperatively. In each case, the fused disc space was mobilized through controlled P-ACR, permitting insertion of an anteriorly positioned expandable cage at L5-S1. The mean lumbar lordosis improved from -28.6° preoperatively to -46.9° postoperatively (mean gain 18.3°). Sagittal vertical axis improved from 107.9 mm to 65.4 mm (mean reduction 42.6 mm, 39.4%). These radiographical gains were accompanied by reductions in pelvic tilt (-13.1°) and improvements in functional status and pain scores.

conclusionL5-S1 IDO with P-ACR offers a posterior-only solution for restoring distal lumbar lordosis in patients with rigid lumbosacral deformity. By enabling anterior cage placement from a posterior corridor, this approach avoids the exposure-related risks of anterior lumbar interbody fusion and the morbidity of pedicle subtraction osteotomy while providing effective correction in heavily scarred revision fields. The stepwise description and illustrative cases may assist spine surgeons in incorporating this technique into practice.

Indexed as

Adult spinal deformityAnterior column releaseExpandable cageFlat-back syndromeIntradiscal osteotomyLordosis restorationLumbosacral fusion

Identifiers

PMID42788111
PMCPMC13606019

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