Spinal osteotomies: indications, limits and pitfalls.
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2017 Apr 27;2(3):73-82. doi: 10.1302/2058-5241.2.160069. eCollection 2017 Mar.
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This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
Abstract
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.
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.
Resumen
Los principales tipos de osteotomías son la osteotomía de Smith-Petersen (SPO), la osteotomía de sustracción de pedículos (PSO), la osteotomía ósea-disco-ósea (BDBO) y la resección de columna vertebral (VCR), en orden de complejidad creciente.SPO es una osteotomía de columna posterior en la que los ligamentos posteriores y las articulaciones de las facetas se eliminan y la corrección se realiza a través del espacio discal. Un disco anterior móvil es esencial. SPO es mejor en pacientes con plumbline C7 de + 6-8 cm. La cantidad de corrección es de 9,3 ° a 10,7 ° / nivel (1 ° / mm de hueso) .PSO es una técnica en la que se eliminan los elementos posteriores y los pedículos. Luego se retira una cuña triangular a través de los pedículos y la espina posterior se acorta utilizando la corteza anterior como una bisagra. Los candidatos ideales son pacientes con un desequilibrio sagital severo. Una osteotomía de un solo nivel puede producir 30 ° 40 ° de corrección. Una osteotomía de un solo nivel puede restablecer el equilibrio sagital global en un promedio de 9 cm con un límite superior de 19 cm.BDBO es una osteotomía realizada por encima y por debajo de un nivel de disco. Un BDBO proporciona tasas de corrección en el intervalo de 35 ° a 60 °. Las principales indicaciones son deformidades con el espacio discal como el ápice y las deformidades severas del plano sagital. VCR está indicado para deformidades rígidas multiplanares, deformidades anguladas agudas, resecciones de hemivertebra, tumores espinales resecables, deformidades postraumáticas y espondiloptosis. La principal indicación de un VCR es la deformidad del plano coronal fijo. El tipo de osteotomía debe elegirse principalmente de acuerdo con la etiología, el tipo y el ápex de la deformidad. Uno puede comenzar con los SPOs y puede avanzar gradualmente a osteotomías complejas
Cite this article: EFORT Open Rev 2017;2:73-82. DOI: 10.1302/2058-5241.2.160069.
PMID: 28507779 PMCID: PMC5420824 DOI: 10.1302/2058-5241.2.160069
PMID: 28507779 PMCID: PMC5420824 DOI: 10.1302/2058-5241.2.160069
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