The Comprehensive Anatomical Spinal Osteotomy Classification

Abstract

This proposed anatomically based classification system provides a consistent description of the various osteotomies performed in spinal deformity correction surgery. The reliability study confirmed that the classification is simple and consistent. Further development of its use will provide a common frame for osteotomy assessment and permit comparative analysis of different treatments.

Sagittal spinopelvic alignment in 654 degenerative spondylolisthesis

“…This important loss of lordosis is mainly explained by local kyphosis at the listhesis level. Eur Spine J However, this group has a low PI (49.1°) so the lordosis needed could be achieved by less invasive surgical procedures than a 3-column osteotomy (3-CO) [33][34][35]. In group 1b, while the lumbar lordosis was adapted to the PI with PI/ LLmax ratio of 104 %, the important thoracic kyphosis (60°) seems to be the main factor in anterior malalignment.…”

Analysis of an unexplored group of sagittal deformity patients: low pelvic tilt despite positive sagittal malalignment

“…While three-column osteotomy (3CO) has been presented as effective technique to restore coronal and sagittal alignment [15][16][17][18][19][20][21], anticipating the postoperative alignment such as change in PT and SVA following 3CO remains challenging. To our knowledge, no studies in the literature have specifically analyzed the efficacy of 3CO for patients with anterior malalignment who have a low preoperative PT, despite an abnormally elevated SVA.…”

Adult deformity correction techniques

“…Schwab et al 18 recently described a classification system for grading both the extent of bony resection and subsequent destabilization in such osteotomies. This system may be used to gauge the varying subtypes in an effort to organize spinal osteotomies based on the degree of correction.…”

“…Always approached from a strictly posterior incision, the bony resection involves partial removal of the inferior articulating facet of the rostral vertebra in addition to joint capsule. 18 This is often referred to as an opening wedge osteotomy because the success of the correction is dependent on a mobile anterior column. Concurrently, as the anterior column opens up, the posterior column is closed down, forcing the spine into extension, whether providing further lordosis in the lumbar spine or correcting a hyperkyphotic deformity in the thoracic spine.…”

“…1 These include a variant of the SPO with a more aggressive facetectomy and the Ponte osteotomy. 18,22 These osteotomies provide approximately 101 of correction at each spinal level. 20 The same limitations with regard to anterior mobility exist as in grade 1 osteotomies if a limited posterior approach is utilized.…”