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Anterior Release Generates More Thoracic Rotation Than Posterior Osteotomy: A Biomechanical Study of Human Cadaver Spines

Wollowick, Adam L. MD*; Farrelly, Erin E. MD*; Meyers, Kathleen MS; Grossman, Seth MD*; Amaral, Terry D. MD*; Wright, Timothy PhD; Sarwahi, Vishal MD*

doi: 10.1097/BRS.0b013e31829a6906

Study Design. Biomechanical testing of human cadaveric spines.

Objective. To determine the effect of anterior and posterior anatomic structures on the rotational stability of the thoracic spine.

Summary of Background Data. Historically, large and/or stiff spinal deformities were treated with anterior release to facilitate correction. However, anterior release increases risks and requires a 2-part procedure. Recently, large or rigid deformities have been treated with a single posterior procedure using pedicle screws and spinal osteotomies. No study has yet evaluated the effect of anterior release or posterior osteotomy on thoracic spinal column rotation.

Methods. Thoracolumbar spines were obtained from cadavers and segmented into upper, middle, and lower specimens. Specimens were cyclically loaded with a ±5 N·m moment in axial rotation for 10 cycles. Specimens were tested intact and then retested after sectioning or removal of each structure to simulate those removed during anterior release and posterior osteotomy. The total increases in axial rotation after posterior and anterior resections were calculated using a 3-dimensional motion capture camera system. For each ligament resection, the absolute and percent change in degrees of rotation was calculated from comparison with the intact specimen. The median data points were compared to account for outliers.

Results. Resection of anterior structures was more efficacious than resection of posterior structures. An 8.8% to 71.9% increase in the amount of axial rotation was achieved by a posterior release, whereas resection of anterior structures led to a 141% to 288% increase in rotation. The differences between the anterior and posterior resections at all levels tested (T2–T3, T6–T7, and T10–T11) were significant (P < 0.05).

Conclusion. Anterior release generated significantly more thoracic rotation than posterior osteotomy in biomechanical testing of human cadaver spines.

Level of Evidence: N/A

Biomechanical study of human cadaver thoracic spines was performed using sequential anatomic sectioning to compare anterior and posterior releases. Anterior release generated significantly more thoracic rotation than posterior osteotomy. Although many surgeons favor a single posterior approach to correct severe spinal deformity, based upon this biomechanical study, anterior surgery addresses derotation better.

*Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; and

Department of Biomechanics, Hospital for Special Surgery, New York, NY.

Address correspondence and reprint requests to Adam L. Wollowick, MD, Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Ave, 6th Floor, Bronx, NY 10467; E-mail:

Acknowledgment date: March 23, 2012. First revision date: September 29, 2012. Second revision date: April 14, 2013. Acceptance date: May 3, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Stryker Spine grant funds were received to support this work.

Relevant financial activities outside the submitted work: consultancy, grants, payment for lecture.

© 2013 by Lippincott Williams & Wilkins