This is a radiologist’s look back at things from the past. The purpose of this study was to show the radiological results of oblique lateral interbody fusion (OLIF) following a modified anterior column realignment (mACR) with partial relaxation of the anterior longitudinal ligament (ALL). 

For increased lordosis, minimally invasive adult spinal deformity surgery frequently combines anterior column realignment (ACR) with posterior column osteotomy (PCO). Because the anterior-to-psoas corridor often involves the anterolateral part of the disk, OLIF is suitable for ACR. There were a total of 112 operative disk levels from 101 patients who underwent OLIF between L2-L3 and L4-L5 with a 12° lateral cage. The mACR was performed at 73 (65.2%) levels and had the ALL sectioned between 30 and 50% before the mACR was carried out. No mACR, OLIF only (n=39); mACR with no PCO (n=18); mACR with grade 1 PCO (n=27); mACR with grade 2 PCO (n=22); and mACR with grade 3 PCO (n=6) were the categories created for each operated level. 

The mean disk lordotic angles at the most recent follow-up were 10.9±2.9° in the no mACR group, 12.6±3.0° in the mACR group with no PCO, 13.3±3.9° in the mACR group with grade 1 PCO, 16.7±3.2° in the mACR group with grade 2 PCO, and 16.8±2.4° in the mACR group with grade 3 PCO, respectively (P<0.001). Mean increases in disk lordotic angle across the 4 groups were 12.1±6.1°, 13.5±8.7°, 15.8±6.7°, and 17.9±6.2°, respectively (P<0.001). 

Partial ALL release allows ACR to be conducted under direct vision in OLIF without undertaking extensive dissection into the ventral disk area. When it comes to anterior column lengthening, mACR with OLIF is a straightforward, risk-free, and very efficient method.