Osteotomies in the posterior-only treatment of complex adult spinal deformity: a comparative review

Abstract

<jats:p>In addressing adult spinal deformities through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. The Ponte or Smith-Petersen osteotomy provides the least correction, but it can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies but carry increased technical demands, longer operative time, and greater blood loss and associated morbidity. Vertebral column resections serve as the most powerful method, providing the most correction in the coronal and sagittal planes, but posing both the greatest technical challenge and the greatest risk to the patient in terms of possible neurological injury, operative time, and potential morbidity. The authors reviewed the literature relating to these osteotomy methods. They also provided case illustrations and suggestions for their proper application.</jats:p>

Alphabet Soup: Sagittal Balance Correction Osteotomies of the Spine—What Radiologists Should Know

“…25 The mean neurologic complication rate is higher than that of SPO: 9.1% in PSO versus 2.1% in SPO. 25 Bone-Disc-Bone Osteotomy.…”

“…The Ponte procedure refers to the resection of multiple facets and spinous processes with posterior decompression along unfused regions of kyphotic deformity in Scheurmann kyphosis. 25,26 This technique is a more commonly used posterior column osteotomy than the originally described SPO; however, the name "SPO" has remained to describe a spectrum of posterior column osteotomies categorized generally under the grade 2 group including the Ponte procedure. 25 Thus, nomenclature confusion can occur at times.…”

“…25,26 This technique is a more commonly used posterior column osteotomy than the originally described SPO; however, the name "SPO" has remained to describe a spectrum of posterior column osteotomies categorized generally under the grade 2 group including the Ponte procedure. 25 Thus, nomenclature confusion can occur at times. In this article, SPO terminology also refers to the Ponte procedure as in other literature.…”

“…Therefore, PSO is typically used for patients with sharp or angular kyphosis as well as at levels lacking anterior flexibility where SPO is inapplicable. 25,31 Analogous to the SPO, the PSO has been also referred to by various alternatives, including closing wedge osteotomy, eggshell osteotomy, and transpedicular wedge procedure. 25 On imaging, PSO may be mistaken for a posterior wedge compression fracture if one is not aware of this type of surgery.…”

“…25,31 Analogous to the SPO, the PSO has been also referred to by various alternatives, including closing wedge osteotomy, eggshell osteotomy, and transpedicular wedge procedure. 25 On imaging, PSO may be mistaken for a posterior wedge compression fracture if one is not aware of this type of surgery. PSO is generally indicated for correction of SVAs of Ͼ10 -12 cm, and it can provide 30°-40°of lordosis correction on average.…”