Complex osteotomies vertebral column resection and decancellation

  • Ibrahim ObeidEmail author
  • Anouar Bourghli
  • Louis Boissière
  • Jean-Marc Vital
  • Cédric Barrey
Expert's Opinion


Pedicle subtraction osteotomy (PSO) is nowadays widely used to treat sagittal imbalance. Some complex malalignment cases cannot be treated by a PSO, whereas the imbalance is coronal or mixed or the sagittal imbalance is major and cannot be treated by a single PSO. The aim of this article was to review these complex situations—coronal imbalance, mixed imbalance, two-level PSO, vertebral column resection, and vertebral column decancellation, and to focus on their specificities. It wills also to evoke the utility of navigation in these complex cases.


Pedicle subtraction osteotomy Sagittal malalignment Adult spinal deformity Vertebral column resection Vertebral column decancellation Navigation 


Conflict of interest



  1. 1.
    Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K (2004) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg Am 86-A(Suppl 1):44–50PubMedGoogle Scholar
  2. 2.
    Thambiraj S, Boszczyk BM (2012) Asymmetric osteotomy of the spine for coronal imbalance: a technical report. Eur Spine J 21(Suppl 2):S225–S229. doi: 10.1007/s00586-012-2171-9 PubMedCrossRefGoogle Scholar
  3. 3.
    Bridwell KH (2006) Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976) 31(19 Suppl):171–178. doi: 10.1097/01.brs.0000231963.72810.38 CrossRefGoogle Scholar
  4. 4.
    Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD, Shah SA, Sides BA, Blanke KM (2013) Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine (Phila Pa 1976) 38(2):119–132. doi: 10.1097/BRS.0b013e318269fab1 CrossRefGoogle Scholar
  5. 5.
    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 (Phila Pa 1976) 34(20):2213–2221. doi: 10.1097/BRS.0b013e3181b53cba CrossRefGoogle Scholar
  6. 6.
    O’Shaughnessy BA, Kuklo TR, Hsieh PC, Yang BP, Koski TR, Ondra SL (2009) Thoracic pedicle subtraction osteotomy for fixed sagittal spinal deformity. Spine (Phila Pa 1976) 34(26):2893–2899. doi: 10.1097/BRS.0b013e3181c40bf2 CrossRefGoogle Scholar
  7. 7.
    Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K (2003) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85-A(3):454–463PubMedGoogle Scholar
  8. 8.
    Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976) 30(14):1682–1687CrossRefGoogle Scholar
  9. 9.
    Suk SI, Chung ER, Lee SM, Lee JH, Kim SS, Kim JH (2005) Posterior vertebral column resection in fixed lumbosacral deformity. Spine (Phila Pa 1976) 30(23):E703–E710CrossRefGoogle Scholar
  10. 10.
    Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH (2002) Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976) 27(21):2374–2382. doi: 10.1097/01.BRS.0000032026.72156.1D CrossRefGoogle Scholar
  11. 11.
    Lenke LG, Sides BA, Koester LA, Hensley M, Blanke KM (2010) Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res 468(3):687–699. doi: 10.1007/s11999-009-1037-x PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Wang Y, Lenke LG (2011) Vertebral column decancellation for the management of sharp angular spinal deformity. Eur Spine J 20(10):1703–1710. doi: 10.1007/s00586-011-1771-0 PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Cui G, Wang Y, Kao TH, Zhang Y, Liu Z, Liu B, Li J, Zhang X, Zhu S, Lu N, Mao K, Wang Z, Yuan X, Dong T, Xiao S (2012) Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine (Phila Pa 1976) 37(10):891–900. doi: 10.1097/BRS.0b013e31823aff81 CrossRefGoogle Scholar
  14. 14.
    Obeid I, Laouissat F, Vital JM (2013) Asymmetric T5 pedicle subtraction osteotomy (PSO) for complex posttraumatic deformity. Eur Spine J 22(9):2130–2135. doi: 10.1007/s00586-013-2942-y PubMedCrossRefGoogle Scholar
  15. 15.
    Elgafy H, Bransford RJ, McGuire RA, Dettori JR, Fischer D (2010) Blood loss in major spine surgery: are there effective measures to decrease massive hemorrhage in major spine fusion surgery? Spine (Phila Pa 1976) 35(9 Suppl):S47–S56. doi: 10.1097/BRS.0b013e3181d833f6 CrossRefGoogle Scholar
  16. 16.
    Cheh G, Lenke LG, Padberg AM, Kim YJ, Daubs MD, Kuhns C, Stobbs G, Hensley M (2008) Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: why does it occur and what should you do? Spine (Phila Pa 1976) 33(10):1093–1099. doi: 10.1097/BRS.0b013e31816f5f73 CrossRefGoogle Scholar
  17. 17.
    Fehlings MG, Brodke DS, Norvell DC, Dettori JR (2010) The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference? Spine (Phila Pa 1976) 35(9 Suppl):S37–S46. doi: 10.1097/BRS.0b013e3181d8338e CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Ibrahim Obeid
    • 1
    Email author
  • Anouar Bourghli
    • 1
  • Louis Boissière
    • 1
  • Jean-Marc Vital
    • 1
  • Cédric Barrey
    • 2
  1. 1.Department of Orthopaedics and Spine SurgeryUniversity Hospital of BordeauxBordeauxFrance
  2. 2.Department of Neurosurgery and Spine Surgery, P Wertheimer Hospital, Hospices Civils de LyonUniversity Claude Bernard Lyon 1LyonFrance

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