Abstract
Corrective osteotomies are used to treat sagittal and coronal imbalance of the spine in patients with a variety of spinal deformities. It is important to be able to recognize the type and underlying cause of the deformity so that the most appropriate osteotomy can be chosen.
The Smith-Petersen osteotomy is relatively simple compared with the other osteotomies and can typically be used to treat type-1 deformities. Also, curves that have a relatively smooth kyphosis instead of a sharp angular kyphosis can be treated with a Smith-Petersen osteotomy. Multiple Smith-Petersen osteotomies can be used to achieve the necessary amount of correction.
Pedicle subtraction osteotomy is typically used in patients with greater imbalances in the sagittal plane of the spine and when a minimum of 30° of correction is needed.
Vertebral column resection is reserved for deformities, such as those in both the sagittal and the coronal plane, that are not amenable to treatment with either a Smith-Petersen osteotomy or a pedicle subtraction osteotomy, or a combination of the two.
Recent results have shown high patient satisfaction rates and good functional outcomes after spinal osteotomies done to treat a variety of disorders. As the level of complexity of the osteotomy increases, so does the potential for complications.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM. Complications and predictive factors for the successful treatament of flatback deformity *fixed sagittal imbalance. Spine. 1999;24:1712–20.
Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine. 2005;30:682–8.
Duval-Beaupère G, Schimdt C, Cosson P. A barycentemetric study of sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng. 1992;20:451–62.
Mac-Thiong J, Berthonnaud E, Dimar Jr II, Betz RR, Labelle H. Sagittal alignment of the spine and pelvis during growth. Spine. 2004;29:1642–7.
Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of sagittal curves. Eur Spine J. 1998;7:99–103.
Wambolt A, Spencer DL. A segmental analysis of the distribution of lumbar lordosis in the normal spine. Orthop Trans. 1987;11:92–3.
Hehne HJ, Zielke K, Bohm H. Polysegmental lumbar osteotomies and transpedicular fixation for correction of long-curved kyphotic defoprmities in ankylosing spondylitis: report of 177 cases. Clin Orthop. 1990;258:49–55.
Bernhard M, Bridwell KH. Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine. 1989;14:717–21.
Cho K, Bridwell KH, Reitenbach AK. Preoperative gait comparisons between adults underging long spinal deformity fusion surgery and controls. Spine. 2001;26:2020–8.
McMaster MJ. Osteotomy of the cervical spine in ankylosing spondylitis. J Bone Joint Surg Br. 1997;79:197–203.
Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM. Complications and predictive factors for the successful treatment of flatback deformity (fixed sagital imbalance). Spine. 1999;24:1712–20.
Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman Jr RA, Kim YJ, Stewart D, Baldus C. Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine. 2007;32:2245–52.
Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg Am. 1945;27:1–11.
Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res. 1985;194:142–52.
Wang MY, Berven SH. Lumbar pedicle subtraction osteotomy. Neurosurgery. 2007;60(2 Suppl 1):ONS140–6.
Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am. 2003;85:454–63.
Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg Am. 2004;86 Suppl 1:44–50.
Urist MR. Osteotomy of the cervical spine; report of a case of ankylosing rheumatoid spondylitis. J Bone Joint Surg Am. 1958;40:833–43.
Van Royen BJ, Slot GH. Closing-wedge posterior osteotomy for ankylosingspondylitis. Partial corporectomy and transpedicular fixation in 22 cases. J Bone Joint Surg Br. 1995;77:117–21.
Lazennec JY, Saillant G, Saidi K, Arafati N, Barabas D, Benazet JP, Laville C, Roy-Camille R, Ramaré S. Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients. Eur Spine J. 1997;6:222–32.
Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine. 2006;31(19 Suppl):S171–8.
Sansur CA, Fu KM, Oskouian Jr RJ, Jagannathan J, Kuntz 4th C, Shaffrey CI. Surgical management of global sagittal deformity in ankylosing spondylitis. Neurosurg Focus. 2008;24:E8.
Cho KJ, Bridwell KH, Lenke LG, Berra A, Baldus C. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagital imbalance. Spine. 2005;30:2030–8.
Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, Lenke LG. Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws. Spine. 2001;26:1976–83.
Kornblatt MD, Casey MP, Jacobs RR. Internal fixation in lumbosacral spine fusion. A biomechanical and clinical study. Clin Orthop Relat Res. 1986;203:141–50.
Macagno AE, O’Brien MF. Thoracic and thoracolumbar kyphosis in adults. Spine. 2006;31(19 Suppl):S161–70.
Lebwohl NH, Cunningham BW, Dmitriev A, Shimamoto N, Gooch L, Devlin V, Boachie-Adjei O, Wagner TA. Biomechanical comparison of lumbosacral fixation techniques in a calf spine model. Spine. 2002;27:2312–20.
McCord DH, Cunningham BW, Shono Y, Myers JJ, McAfee PC. Biomechanical analysis of lumbosacral fixation. Spine. 1992;17(8 Suppl):S235–43.
Edwards 2nd CC, Bridwell KH, Patel A, Rinella AS, Jung Kim Y, Berra AB, Della Rocca GJ, Lenke LG. Thoracolumbar deformity arthrodesis to L5 in adults: the fate of the L5-S1 disc. Spine. 2003;28:2122–31.
Polly Jr DW, Hamill CL, Bridwell KH. Debate: to fuse or not to fuse to the sacrum, the fate of the L5-S1 disc. Spine. 2006;31(19 Suppl):S179–84.
Kuhns CA, Bridwell KH, Lenke LG, Amor C, Lehman RA, Buchowski JM, Edwards 2nd C, Christine B. Thoracolumbar deformity arthrodesis stopping at L5: fate of the L5-S1 disc, minimum 5-year follow-up. Spine. 2007;32:2771–6.
Lagrone MO, Bradford DS, Moe JH, Lonstein JE, Winter RB, Ogilvie JW. Treatment of symptomatic flatback after spinal fusion. J Bone Joint Surg Am. 1988;70:569–80.
Bridwell KH, Lewis SJ, Edwards C, Lenke LG, Iffrig TM, Berra A, Baldus C, Blanke K. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine. 2003;28:2093–101.
Berven SH, Deviren V, Smith JA, Emami A, Hu SS, Bradford DS. Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine. 2001;26:2036–43.
Hoh DJ, Khoueir P, Wang MY. Management of cervical deformity in ankylosing spondylitis. Neurosurg Focus. 2008;24:E9.
Bradford DS, Tribus CB. Vertebral column resection for the treatment of rigid coronal decompensation. Spine. 1997;22:1590–9.
Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK. Posterior vertebral column resection for severe rigid scoliosis. Spine. 2005;30:1682–7.
Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH. Posterior vertebral column resection for severe spinal deformities. Spine. 2002;27:2374–82.
Bradford DS, Boachie-Adjei O. One-stage anterior and posterior hemivertebral resection and arthrodesis for congenital scoliosis. J Bone Joint Surg Am. 1990;72:536–40.
Ponte A. Posterior column shortening for Scheuermann’s kyphosis: an innovative one-stage technique. In: Haher TR, Merola AA, editors. Surgical techniques for the spine. New York: Thieme Medical; 2003. p. 107–13.
Geck MJ, Macagno A, Ponte A, Shufflebarger HL. The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech. 2007;20:586–93.
Kim YJ, Bridwell KH, Lenke LG, Cheh G, Baldus C. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine. 2007;32:2189–97.
Suk SI, Kim JH, Lee SM, Chung ER, Lee JH. Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine. 2003;28:2170–5.
Belanger TA, Milam 4th RA, Roh JS, Bohlman HH. Cervicothoracic extensión osteotomy for chin-on-chest deformity in ankylosing spondylitis. J Bone Joint Surg Am. 2005;87:1732–8.
Suk SI, Chung ER, Lee SM, Lee JH, Kim SS, Kim JH. Posterior vertebral column resection in fixed lumbosacral deformity. Spine. 2005;30:E703–10.
Adams JC. Technique, dangers and safeguards in osteotomy of the spine. J Bone Joint Surg Br. 1952;34:226–32.
McMaster MJ. A technique for lumbar spinal osteotomy in ankylosing spondylitis. J Bone Joint Surg Br. 1985;67:204–10.
Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH. Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine. 2007;32:2238–44.
Yang BP, Ondra SL, Chen LA, Jung HS, Koski TR, Salehi SA. Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. J Neurosurg Spine. 2006;5:9–17.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 EFORT
About this entry
Cite this entry
Palou, E.C. (2014). Spinal Osteotomy – Indications and Techniques. In: Bentley, G. (eds) European Surgical Orthopaedics and Traumatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-34746-7_223
Download citation
DOI: https://doi.org/10.1007/978-3-642-34746-7_223
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-34745-0
Online ISBN: 978-3-642-34746-7
eBook Packages: MedicineReference Module Medicine