Spinal Osteotomies
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Spinal Osteotomies
What is a Spinal Osteotomy?
Spinal osteotomy is a procedure where a cut is made into one of the bones of the spine to allow for correction of spinal alignment. There are a number of different types of osteotomy. The specific osteotomy used in any case depends on the location of the spinal deformity to be corrected as well as the amount of correction that is needed. Spinal osteotomies are used as part of a spinal reconstructive procedure in order to achieve spinal balance and stability. Spinal instrumentation (rods and screws) are used as part of a spinal realignment procedure to hold the spine in correct alignment while spinal fusion occurs. Spinal fusion is a process where the bones of the spine heal together or mend into one solid piece. Once this occurs the spine will be stable in that area and further curvature or progression is unlikely.
Complex spinal deformities demand spinal osteotomies
What are the types of spinal osteotomies?
Smith-Peterson osteotomy (posterior column osteotomy) is a procedure where a portion of the bone in the back portion of the spine may be removed. When this bone is removed it creates a space and when this space is closed down it allows the bones in the back of the spine come closer together, therefore “leaning” the spine more toward the back. Smith-Peterson osteotomy may be performed at one location or multiple locations along the spine to allow the surgeon to restore lordosis in the area of the osteotomy.
Smith Peterson Osteotomy - The correction is obtained through compression of the osteotomy with instrumentation and by disc deformation
Correction of Kyphosis with SPO
A pedicle subtraction osteotomy (PSO) is performed by removing the posterior element and facet joints similar to a Smith-Peterson osteotomy. The PSO then involves removing the remaining posterior elements and pedicles of the vertebral body then working around the nerves of the spine into the front portion of the spine and a portion of the vertebral body is removed, usually in a wedge [Figure 3]. This osteotomy involves all three columns of the spine (posterior, middle, and anterior). The correction of the lordosis with this osteotomy is greater.
Pedicle Substraction Osteotomy- V-shaped resection that removes the posterior elements, pedicles and part of the vertebral body
Post –traumatic Kyphosis treated by Pedicle Subtraction osteotomy
Vertebral column resection (VCR) allows the largest correction of any spinal osteotomy. During the vertebral column resection, one entire segment of the spine is removed. This procedure was initially described through an anterior and posterior combined approach. More recently the VCR has been performed through a posterior only approach and is shown to be safe and effective for many patients.
Spinal kyphosis can be treated by VCR technique to achieved a well-balanced spine
Patient with post-tubercular kyphosis treated by VCR
When is a spinal osteotomy indicated?
Spinal deformity correction surgery with osteotomy is an option for the patient if the nonsurgical treatments do not relieve their pain or symptoms. Surgery is also needed for patients whose deformity is getting worse over time or who have curvatures that are leading to nerve compression causing symptoms such as numbness, weakness, or pain. Surgical reconstruction involves some correction of the curvature, with the goal of the surgery being to relieve pain and to prevent the curvature from getting worse in the future.
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