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

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.

[1]  G. Qiu,et al.  [The efficacy and complications of one stage posterior vertebral column resection for severe spinal deformities]. , 2010, Zhonghua wai ke za zhi [Chinese journal of surgery].

[2]  L. Lenke,et al.  Vertebral Column Resection for the Treatment of Severe Spinal Deformity , 2010, Clinical orthopaedics and related research.

[3]  L. Lenke,et al.  Posterior Vertebral Column Resection for Severe Pediatric Deformity: Minimum Two-Year Follow-up of Thirty-Five Consecutive Patients , 2009, Spine.

[4]  Z. Gokaslan,et al.  Posterior vertebral column subtraction osteotomy: a novel surgical approach for the treatment of multiple recurrences of tethered cord syndrome. , 2009, Journal of neurosurgery. Spine.

[5]  T. Kiaer,et al.  Transpedicular closed wedge osteotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis , 2009, European Spine Journal.

[6]  C. Bono,et al.  DECISION MAKING IN ADULT DEFORMITY , 2008, Neurosurgery.

[7]  S. Dhall,et al.  PEDICLE SUBTRACTION OSTEOTOMY , 2008, Neurosurgery.

[8]  Z. Wang,et al.  A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases , 2008, European Spine Journal.

[9]  H. Shufflebarger,et al.  The Ponte Procedure: Posterior Only Treatment of Scheuermann's Kyphosis Using Segmental Posterior Shortening and Pedicle Screw Instrumentation , 2007, Journal of spinal disorders & techniques.

[10]  J. Buchowski,et al.  Neurologic Complications of Lumbar Pedicle Subtraction Osteotomy: A 10-Year Assessment , 2007, Spine.

[11]  L. Lenke,et al.  Results of Lumbar Pedicle Subtraction Osteotomies for Fixed Sagittal Imbalance: A Minimum 5-Year Follow-up Study , 2007, Spine.

[12]  M. Takemoto,et al.  Clinical outcomes and complications after pedicle subtraction osteotomy for correction of thoracolumbar kyphosis. , 2007, Journal of neurosurgery. Spine.

[13]  T. Witham,et al.  THORACIC KYPHOTIC DEFORMITY REDUCTION WITH A DISTRACTIBLE TITANIUM CAGE VIA AN ENTIRELY POSTERIOR APPROACH , 2007, Neurosurgery.

[14]  M. Crocker,et al.  Total thoracic vertebrectomy with anterior and posterior column reconstruction via single posterior approach , 2007, British journal of neurosurgery.

[15]  Tian Hui-zhon.  Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach , 2007 .

[16]  S. Ondra,et al.  Mathematical Calculation of Pedicle Subtraction Osteotomy Size to Allow Precision Correction of Fixed Sagittal Deformity , 2006, Spine.

[17]  P. Boyer,et al.  Wedge Osteotomy for Treating Post-traumatic Kyphosis at Thoracolumbar and Lumbar Levels , 2006, Journal of spinal disorders & techniques.

[18]  K. Bridwell.  Decision Making Regarding Smith-Petersen vs. Pedicle Subtraction Osteotomy vs. Vertebral Column Resection for Spinal Deformity , 2006, Spine.

[19]  S. Ondra,et al.  Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. , 2006, Journal of neurosurgery. Spine.

[20]  C. Wolfla,et al.  Single-stage Thoracolumbar Vertebrectomy with Circumferential Reconstruction and Arthrodesis: Surgical Technique and Results in 15 Patients , 2006, Neurosurgery.

[21]  Piet J.M. van Loon,et al.  A pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of a rigid thoracolumbar hyperkyphosis; a preliminary report , 2006 .

[22]  Jung-Hee Lee,et al.  Posterior Vertebral Column Resection in Fixed Lumbosacral Deformity , 2005, Spine.

[23]  L. Lenke,et al.  Comparison of Smith-Petersen Versus Pedicle Subtraction Osteotomy for the Correction of Fixed Sagittal Imbalance , 2005, Spine.

[24]  O. Hägg,et al.  A practical approach to spine registers in Europe: the Swedish experience , 2005, European Spine Journal.

[25]  L. Lenke,et al.  Complications and Outcomes of Pedicle Subtraction Osteotomies for Fixed Sagittal Imbalance , 2003, Spine.

[26]  C. Shaffrey,et al.  Management of iatrogenic flat-back syndrome. , 2003, Neurosurgical focus.

[27]  L. Lenke,et al.  Pedicle Subtraction Osteotomy for the Treatment of Fixed Sagittal Imbalance , 2003, The Journal of bone and joint surgery. American volume.

[28]  Christopher,et al.  Management of iatrogenic flatback syndrome , 2003 .

[29]  D. Murrey,et al.  Transpedicular Decompression and Pedicle Subtraction Osteotomy (Eggshell Procedure): A Retrospective Review of 59 Patients , 2002, Spine.

[30]  S. Suk,et al.  Posterior Vertebral Column Resection For Severe Spinal Deformities , 2002, Spine.

[31]  K. Suk,et al.  Clinical Outcome Results of Pedicle Subtraction Osteotomy in Ankylosing Spondylitis With Kyphotic Deformity , 2002, Spine.

[32]  J. Webb,et al.  Excision of hemivertebrae in the management of congenital scoliosis. , 2002, The Journal of bone and joint surgery. British volume.

[33]  Fang Li,et al.  Comparative Evaluation of Single-Level Closing-Wedge Vertebral Osteotomies for the Correction of Fixed Kyphotic Deformity of the Lumbar Spine: A Cadaveric Study , 2001, Spine.

[34]  V. Deviren,et al.  Management of Fixed Sagittal Plane Deformity: Results of the Transpedicular Wedge Resection Osteotomy , 2001, Spine.

[35]  Tzai-Chiu Yu,et al.  Transpedicular Wedge Osteotomy for Correction of Thoracolumbar Kyphosis in Ankylosing Spondylitis: Experience With 78 Patients , 2001, Spine.

[36]  V. Deviren,et al.  Excision of hemivertebrae in the management of congenital scoliosis involving the thoracic and thoracolumbar spine. , 2001, The Journal of bone and joint surgery. British volume.

[37]  O. Danisa,et al.  Surgical correction of lumbar kyphotic deformity: posterior reduction "eggshell" osteotomy. , 2000, Journal of neurosurgery.

[38]  A. Gast,et al.  Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment , 1999 .

[39]  I. McCutcheon,et al.  Single-stage posterior vertebrectomy and replacement combined with posterior instrumentation for spinal metastasis. , 1996, Journal of neurosurgery.

[40]  L. Keppler,et al.  Posterior Transvertebral Osteotomy for Adult Thoracolumbar Kyphosis , 1994, Spine.

[41]  J. N. Suraiya,et al.  Circumdural decompression by posterior vertebrectomy for relief of cord compression due to metastatic disease of thoracic and lumbar spine. , 1992, Indian journal of cancer.

[42]  D. Jaffray,et al.  Closing wedge osteotomy with transpedicular fixation in ankylosing spondylitis. , 1992, Clinical orthopaedics and related research.

[43]  O. Boachie-Adjei,et al.  Vertebral column resection and arthrodesis for complex spinal deformities. , 1991, Journal of spinal disorders.

[44]  K. Zielke,et al.  Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis. Report on 177 cases. , 1990, Clinical orthopaedics and related research.

[45]  F. Magerl,et al.  Total posterior vertebrectomy of the thoracic or lumbar spine. , 1988, Clinical orthopaedics and related research.

[46]  D. Jaffray,et al.  Vascular Complications Associated with Osteotomy in Ankylosing Spondylitis: A Report of Two Cases , 1988, Spine.

[47]  E. Thomasen.  Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. , 1985, Clinical orthopaedics and related research.

[48]  C. Larson,et al.  Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. , 1969, Clinical orthopaedics and related research.

[49]  P. D. Wilson,et al.  Possible mechanism of aortic rupture in orthopaedic correction of rheumatoid spondylitis. , 1956, The Journal of bone and joint surgery. American volume.

[50]  S. Zuckerman.  MORPHOLOGICAL AND FUNCTIONAL HOMOLOGIES OF THE MALE AND FEMALE REPRODUCTIVE SYSTEMS * , 1936, British medical journal.