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2017 ; 2
(3
): 73-82
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Spinal osteotomies: indications, limits and pitfalls
#MMPMID28507779
Kose KC
; Bozduman O
; Yenigul AE
; Igrek S
EFORT Open Rev
2017[Mar]; 2
(3
): 73-82
PMID28507779
show ga
The aims of spinal deformity surgery are to achieve balance, relieve pain and
prevent recurrence or worsening of the deformity.The main types of osteotomies
are the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO),
bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR), in order of
increasing complexity.SPO is a posterior column osteotomy in which the posterior
ligaments and the facet joints are removed and correction is performed through
the disc space. A mobile anterior disc is essential. SPO is best in patients with
+6-8 cm C7 plumbline. The amount of correction is 9.3° to 10.7°/level (1°/mm
bone).PSO is a technique where the posterior elements and pedicles are removed.
Then a triangular wedge through the pedicles is removed and the posterior spine
is shortened using the anterior cortex as a hinge. The ideal candidates are
patients with a severe sagittal imbalance. A single level osteotomy can produce
30° 40° of correction. A single level osteotomy may restore global sagittal
balance by an average of 9 cm with an upper limit of 19 cm.BDBO is an osteotomy
done above and below a disc level. A BDBO provides correction rates in the range
of 35° to 60°. The main indications are deformities with the disc space as the
apex and severe sagittal plane deformities.VCR is indicated for rigid
multi-planar deformities, sharp angulated deformities, hemivertebra resections,
resectable spinal tumours, post-traumatic deformities and spondyloptosis. The
main indication for a VCR is fixed coronal plane deformity.The type of osteotomy
must be chosen mainly according to the aetiology, type and apex of the deformity.
One may start with SPOs and may gradually advance to complex osteotomies. Cite
this article: EFORT Open Rev 2017;2:73-82. DOI: 10.1302/2058-5241.2.160069.