European Spine Journal

, Volume 22, Supplement 2, pp 254–264 | Cite as

Osteotomies/spinal column resections in adult deformity

  • Meric Enercan
  • Cagatay Ozturk
  • Sinan Kahraman
  • Mercan Sarıer
  • Azmi Hamzaoglu
  • Ahmet AlanayEmail author
Review Article


Osteotomies may be life saving procedures for patients with rigid severe spinal deformity. Several different types of osteotomies have been defined by several authors. To correct and provide a balanced spine with reasonable amount of correction is the ultimate goal in deformity correction by osteotomies. Selection of osteotomy is decided by careful preoperative assessment of the patient and deformity and the amount of correction needed to have a balanced spine. Patient’s general medical status and surgeon’s experience levels are the other factors for determining the ideal osteotomy type. There are different osteotomy options for correcting deformities, including the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR) providing correction of the sagittal and multiplanar deformity. SPO refers to a posterior column osteotomy in which the posterior ligaments and facet joints are removed and a mobile anterior disc is required for correction. PSO is performed by removing the posterior elements and both pedicles, decancellating vertebral body, and closure of the osteotomy by hinging on the anterior cortex. BDBO is an osteotomy that aims to resect the disc with its adjacent endplate(s) in deformities with the disc space as the apex or center of rotational axis (CORA). VCR provides the greatest amount of correction among other osteotomy types with complete resection of one or more vertebral segments with posterior elements and entire vertebral body including adjacent discs. It is also important to understand sagittal imbalance and the surgeon must consider global spino-pelvic alignment for satisfactory long-term results. Vertebral osteotomies are technically challenging but effective procedures for the correction of severe adult deformity and should be performed by experienced surgeons to prevent catastrophic complications.


Adult Spine Deformity Osteotomy 


Conflict of interest



  1. 1.
    Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976) 27:387–392Google Scholar
  2. 2.
    Heary RF (2004) Evaluation and treatment of adult spinal deformity. J Neurosurg Spine 1:9–18PubMedCrossRefGoogle Scholar
  3. 3.
    Cho W, Lenke LG (2010) Vertebral osteotomies—review of current concepts. Musculoskeletal Rev 5:46–49Google Scholar
  4. 4.
    Aebi M (2005) The adult scoliosis. Eur Spine J 14:925–948PubMedCrossRefGoogle Scholar
  5. 5.
    Silva FE, Lenke LG (2010) Adult degenerative scoliosis: evaluation and management. Neurosurg Focus 28(3):1–10CrossRefGoogle Scholar
  6. 6.
    Birknes JK, White AP, Albert TJ, Shaffrey CI, Harrop JS (2008) Adult degenerative scoliosis a review. Neurosurgery 63(3):94–103PubMedCrossRefGoogle Scholar
  7. 7.
    Dorward GI, Lenke GL (2010) Osteotomies in the posterior only treatment of complex adult spinal deformity: a comparative review. Neurosurg Focus 28(3):1–10CrossRefGoogle Scholar
  8. 8.
    Bridwell KH (2006) Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine 31(19):171–178CrossRefGoogle Scholar
  9. 9.
    Lafage V, Schwab F, Patel A et al (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 34:599–606Google Scholar
  10. 10.
    Schwab F, Patel A, Ungar B et al (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35:2224–2231Google Scholar
  11. 11.
    Bernhart M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of normal thoracic and lumbar spines and thoracolumbar junction. Spine 14(7):717–721CrossRefGoogle Scholar
  12. 12.
    Ondra SL, Marzouk S, Koski T, Silva F, Salehi S (2006) Mathematical calculation of pedicle subtraction osteotomy size to allow precision correction of fixed sagittal deformity. Spine 25:973–979CrossRefGoogle Scholar
  13. 13.
    Smith-Petersen MN, Larson EB, AuFranc OE (1945) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg Am 27:1–11Google Scholar
  14. 14.
    Ponte A, Vero B, Siccardi GL (1984) Surgical treatment of Scheuermann’s kyphosis. In: Winter RB (ed) Progress in spinal pathology: kyphosis. Aulo Gaggi, Bologna, pp 75–80Google Scholar
  15. 15.
    Cho KJ, Bridwell KH, Lenke GL, Berra A, Baldus C (2005) Comparison of Smith-Petersen versus pedicle substraction osteotomy for correction of fixed sagittal imbalance. Spine 30(18):2030–2037PubMedCrossRefGoogle Scholar
  16. 16.
    Thomasen E (1985) Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res 194:142–152PubMedGoogle Scholar
  17. 17.
    Heining CA (1984) Eggshell procedure. In: Luque ER (ed) Segmental spinal instrumentation. Thorofare, Slack, pp 221–230Google Scholar
  18. 18.
    Kim JY, Bridwell KH, Lenke GL, Cheh GE, Baldus C (2007) Results of lumbar pedicle substraction osteotomies of fixed sagittal imbalance a minimum 5-year follow-up study. Spine 32(20):2189–2197PubMedCrossRefGoogle Scholar
  19. 19.
    Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman RA, Kim JY, Stewart D, Baldus C (2007) Neurologic complications of lumbar pedicle subtraction osteotomy a 10-year assessment. Spine 32(20):2245–2252PubMedCrossRefGoogle Scholar
  20. 20.
    Yang BP, Ondra SL, Chen LA et al (2006) Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. J Neurosurg Spine 5:9–17PubMedCrossRefGoogle Scholar
  21. 21.
    Ahn UM, Ahn NU, Buchowski JM et al (2002) Functional outcome and radiographic correction after spinal osteotomy. Spine 27:1303–1311PubMedCrossRefGoogle Scholar
  22. 22.
    Domanic U, Talu U, Dikici F, Hamzaoglu A (2004) Surgical correction kyphosis; posterior total wedge resection osteotomy in 32 patients. Acta Orthop Scand 75(4):449–455PubMedCrossRefGoogle Scholar
  23. 23.
    Hamzaoglu A, Alanay A, Ozturk C, Sarier M, Karadereler S, Ganiyusufoglu K (2011) Posterior vertebral column resection in severe spinal deformities. Spine 36(5):340–344Google Scholar
  24. 24.
    Ozturk C, Alanay A, Ganiyusufoglu K, Karadereler S, Ulusoy L, Hamzaoglu A (2011) Short term X-ray results of posterior vertebral column resection in severe congenital kyphosis, scoliosis and kyphoscoliosis Spine [Publish Ahead of Print]Google Scholar
  25. 25.
    MacLennan A (1922) Scoliosis. BMJ 2:865–866Google Scholar
  26. 26.
    Suk SI, Chung ER, Kim JH et al (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine 30(14):1682–1687PubMedCrossRefGoogle Scholar
  27. 27.
    Lenke LG, O’Leary PT, Bridwell KH, Sides BA, Koester LA, Blanke KM (2009) Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine 34:2213–2221PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Meric Enercan
    • 1
  • Cagatay Ozturk
    • 1
  • Sinan Kahraman
    • 1
  • Mercan Sarıer
    • 1
  • Azmi Hamzaoglu
    • 1
  • Ahmet Alanay
    • 1
    Email author
  1. 1.Department of Orthopaedics and Traumatology, Istanbul Spine Center at Florence Nightingale HospitalIstanbul Bilim University Faculty of MedicineIstanbulTurkey

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