Osteotomies/spinal column resections in adult deformity

Abstract

Osteotomies may be life saving procedures for patients with rigid severe spinal deformity. Several different types of osteotomies have been defined by several authors. To correct and provide a balanced spine with reasonable amount of correction is the ultimate goal in deformity correction by osteotomies. Selection of osteotomy is decided by careful preoperative assessment of the patient and deformity and the amount of correction needed to have a balanced spine. Patient's general medical status and surgeon's experience levels are the other factors for determining the ideal osteotomy type. There are different osteotomy options for correcting deformities, including the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR) providing correction of the sagittal and multiplanar deformity. SPO refers to a posterior column osteotomy in which the posterior ligaments and facet joints are removed and a mobile anterior disc is required for correction. PSO is performed by removing the posterior elements and both pedicles, decancellating vertebral body, and closure of the osteotomy by hinging on the anterior cortex. BDBO is an osteotomy that aims to resect the disc with its adjacent endplate(s) in deformities with the disc space as the apex or center of rotational axis (CORA). VCR provides the greatest amount of correction among other osteotomy types with complete resection of one or more vertebral segments with posterior elements and entire vertebral body including adjacent discs. It is also important to understand sagittal imbalance and the surgeon must consider global spino-pelvic alignment for satisfactory long-term results. Vertebral osteotomies are technically challenging but effective procedures for the correction of severe adult deformity and should be performed by experienced surgeons to prevent catastrophic complications.

The results of closing wedge osteotomy with posterior instrumented fusion for the surgical treatment of congenital kyphosis

“…There are different types of osteotomies including Smith-Peterson osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disk-bone osteotomy (BDBO) and vertebral column resection (VCR) for deformity correction and maintenance of sagittal and coronal balance [14] In the current report, all of the patients were older than 8 years and local kyphosis angles were significant ([60°), thus, we decided to perform closing wedge osteotomy followed by posterior instrumented fusion for the management of kyphotic deformity.…”

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

“…PSO is generally indicated for correction of SVAs of Ͼ10 -12 cm, and it can provide 30°-40°of lordosis correction on average. 31,32 In this technique, along with pedicle screw posterior fixation, wide laminectomies are performed at adjacent levels to protect the exiting nerve roots. Interbody fusion at levels above and below the osteotomy may be performed to avoid pseudoarthrosis.…”

“…There are 3 types of BDBO, with lordosis correction ranging from 35°to 60° (Fig 4). 32 In type 1, the inferior portion of the target vertebra, along with the disc and superior endplate below it, is involved. In type 2 or extended PSO, PSO is extended to involve the disc and inferior endplate of the vertebra above it.…”

Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis

“…In 1922, MacLennan first reported on VCR via both anterior and posterior approaches. 1 In 2005, Suk et al 10 reported on a single posterior VCR (PVCR) technique. The technique can effectively correct lateral and rotational deformity of the spine.…”

“…The previous year, Heining 3 described an "eggshell" osteotomy-a transpedicular decancellation closed-wedge osteotomyas a variant of the PSO. 1 Compared with the SPO, the PSO can achieve the purpose of 3-column osteotomy, which not only promotes bone healing after shortening of the spine but also effectively avoids stretching the major vessels and viscera anterior to the spine, which can be caused by opening of the vertebrae after SPO. Single-segment PSO can correct 30°-40° of kyphosis, but for a kyphotic angle of > 60°, it is difficult to achieve a good correction effect using a single-segment PSO.…”