Posterior thoracic osteotomies
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Spinal osteotomies are used to treat partially flexible and fixed deformities. Fixed thoracic spinal deformities have been traditionally treated with anterior release and posterior correction with fusion. In recent decades, it has been shown that posterior-only osteotomies might be sufficient to achieve proper deformity correction with lower complication rates than with combined anterior and posterior procedures. Different types of osteotomies have been described to treat spinal deformities through a single posterior approach. These include posterior column osteotomies such as the Smith-Petersen osteotomy and the Ponte osteotomy, and three-column osteotomies such as the pedicle subtraction osteotomy, the posterior vertebral column resection and the posterior vertebral column decancellation. In general, three-column osteotomies are most commonly performed in the lumbar spine, where the vast majority of reports have focused on. They can also be performed in the thoracic spine in the setting of rigid thoracic deformity. A progressive increase in complications has been reported with more aggressive osteotomies. The aim of this article was to describe the most common posterior spinal osteotomies used to treat adult thoracic spinal deformities, with special emphasis on the technical aspects, complications and outcomes, based on current publications and European Spine Study Group (ESSG) data.
KeywordsThoracic spine osteotomy Posterior column osteotomy Pedicle subtraction osteotomy Posterior vertebral column resection Spinal osteotomy complications
We acknowledge DepuySynthes Spine for its funding support.
Conflict of interest
Dr. Pellisé reports grants from Depuy Synthes Spine, during the conduct of the study; grants and personal fees from Depuy Synthes Spine, grants from K2 M, personal fees from Biomet, outside the submitted work. Dr. Vila-Casademunt reports grants from Depuy Synthes Spine, during the conduct of the study; grants from Depuy Synthes Spine, outside the submitted work. Dr. (ESSG) reports grants from Depuy Synthes Spine, during the conduct of the study; grants from Depuy Synthes Spine, outside the submitted work.
- 2.Bradford DS, Moe JH, Montalvo FJ, Winter RB (1974) Scheurmann’s kyphosis and roundback deformity; results of Milwaukee brace treatment. JBJS 56A:740–758Google Scholar
- 3.Fon GT, Pitt MJ, Thies AC Jr (1980) Thoracic kyphosis: range in normal subjects. Am J Radiol 134:979–983Google Scholar
- 4.Moe JH, Winter RB, Bradford DS, Lonstein JE (1978) Kyphosis; general principles. Chap 13. Scoliosis and other spinal deformities. WB Saunders Company, Philadelphia, pp 325–330Google Scholar
- 16.Bridwell KH (2006) Decision making regarding Smith Petersen vs pedicle substraction osteotomy vs vertebral column resection for spinal deformity. Spine 31(19, suppl):5171–5178Google Scholar
- 22.Smith-Petersen MN, Larson CB, Aufranc OE (1945) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. JBJS 27:1–11Google Scholar
- 23.Mc Master MJ (1985) A technique for lumbar spinal osteotomy in ankylosing spondilytis. JBJS Br 67:204–210Google Scholar
- 25.Ponte A, Vero B, Siccardi G (1984) Surgical treatment of Scheuermann’s hyperkyphosis. In: Winter R (ed) Progress in spinal pathology: kyphosis. Aulo Gaggi, Bologna, Italy, pp 75–81Google Scholar
- 26.Smith JS, Sansur CA, Donaldson WF III, Perra JH, Mudiyam R, Choma TJ, Zeller RD, Knapp DR Jr, Noordeen HH, Berven SH, Goytan MJ, Oheneba Boachie-Adjei Shaffrey CI (2011) Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine 36(12):958–964PubMedCrossRefGoogle Scholar
- 28.Michele AA, Krueger FJ (1949) Surgical approach to the vertebral body. J Bone Joint Surg Am 31(4):873–878Google Scholar
- 29.Thomasen E (1985) Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res (194):142–152Google Scholar
- 31.Papadopoulos EC, Boachie-Adjei O, Hess WF, Sánchez Pérez-Grueso FJ, Pellisé F, Gupta M, Lonner B, Paonessa K, Faloon M, Cunningham ME, Kim HJ, Mendelow M, Sacramento C, Yazici M, and Foundation of orthopedis and Complex Spine, New York, NY (2013):Early outcomes and complications of posterior vertebral column ressection. Spine J. doi: 10.1016/j.spinee.2013.03.023
- 33.Boachie-Adjei O (2010) Expert’s comment concerning Grand Rounds case entitled Severe Kyphoscoliosis after primary echinococcus granulosus infection of the spine (by M. Thaler, M. Gabl, R. Lechner, M. Gstöttner and C.M. Bach). Eur Spine J 19(9):1423–1424. doi: 10.1007/s00586-010-1408-8