Skip to main content
SpringerLink
Log in

Lumbar Osteotomy Techniques

  • Chapter
  • First Online:
Essentials of Spinal Stabilization

  • 1253 Accesses

Abstract

The objective of this chapter is to discuss the decision-making and surgical technique of lumbar osteotomies for treatment of malalignment. A comprehensive literature review was performed on the history, indications, preoperative evaluation, and decision-making in patients with sagittal and coronal plane malalignment, as well as surgical technique for lumbar osteotomies. There has been an evolution of many different types of osteotomies for correcting deformities; however, three general categories exist: (1) posterior column osteotomy (PCO), (2) pedicle subtraction osteotomy (PSO), and (3) vertebral column resection (VCR). More recently, the Schwab classification describes six anatomically defined osteotomies that are commonly accepted and used. Utilizing the best available evidence, we review the indications and patient selection as a first step and then discuss the decision-making and preoperative planning. Lastly, we detail the surgical technique with emphasis on complication avoidance.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cheng JS. The epidemiology of adult spinal deformity and the aging population. In: Wang YM, Lu Y, Anderson GD, Mummaneni VP, editors. Minimally invasive spinal deformity surgery: an evolution of modern techniques. Vienna: Springer Vienna; 2010.

    Google Scholar 

  2. Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976). 2005;30(6):682–8.

    Article  Google Scholar 

  3. O’Shaughnessy BA, Ondra SL. Measuring, preserving, and restoring sagittal spinal balance. Neurosurg Clin N Am. 2007;18(2):347–56.

    Article  PubMed  Google Scholar 

  4. Schwab F, Lafage V, Boyce R, Skalli W, Farcy JP. Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine. 2006;31(25):E959–67.

    Article  PubMed  Google Scholar 

  5. Umehara S, Zindrick MR, Patwardhan AG, et al. The biomechanical effect of postoperative Hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine. 2000;25(13):1617–24.

    Article  CAS  PubMed  Google Scholar 

  6. Aebi M. The adult scoliosis. Eur Spine J. 2005;14(10):925–48.

    Article  PubMed  Google Scholar 

  7. Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 2013;74(1):112–20.

    Article  Google Scholar 

  8. Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res. 1969;66:6–9.

    CAS  PubMed  Google Scholar 

  9. Cho KJ, Lenke LG, Berra A, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine. 2005;30(18):2030–7.

    Article  PubMed  Google Scholar 

  10. Hehne HJ, Zielke K, Bohm H. Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis. Clin Orthop Relat Res. 1990a;258:49–55.

    Google Scholar 

  11. Ondra SL, Marzouk S, Koski T, et al. Mathematical calculation of pedicle subtraction osteotomy size to allow precision correction of fixed sagittal deformity. Spine. 2006;31(25):E973–9.

    Article  PubMed  Google Scholar 

  12. Geck MJ, Macagno A, Ponte A, Shufflebarger HL. The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech. 2007;20(8):586–93.

    Article  PubMed  Google Scholar 

  13. Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res. 1985;194:142–52.

    Google Scholar 

  14. Wang MY, Berven SH. Lumbar pedicle subtraction osteotomy. Neurosurgery. 2007;60(2 Suppl 1):ONS140–6.

    PubMed  Google Scholar 

  15. Bridwell KH, Lewis SJ, Edwards C, et al. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine. 2003;28(18):2093–101.

    Article  PubMed  Google Scholar 

  16. Vauzelle C, Stagnara P, Jouvinroux P. Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop Relat Res. 1973;93:173–8.

    Article  Google Scholar 

  17. Nash CL, Loring RA, Schatzinger LA, et al. Spinal cord monitoring during operative treatment of the spine. Clin Orthop Relat Res. 1977;126:100–5.

    Google Scholar 

  18. Tamaki T, Kubota S. History of the development of intraoperative spinal cord monitoring. Eur Spine J. 2007;16(2):S140–6.

    Article  PubMed  Google Scholar 

  19. Gum JL, Buchowski JM, Lenke L, et al. Utilization trends of pedicle subtraction osteotomies compared to posterior spinal fusion for deformity: a national database analysis between 2008–2011. Scoliosis. 2016: In Press.

    Google Scholar 

  20. Sponseller PD, Jain A, Lenke LG, et al. Vertebral column resection in children with neuromuscular spine deformity. Spine (Phila Pa 1976). 2012;37(11):E655–61.

    Article  Google Scholar 

  21. Kelly MP, Lenke LG, Shaffrey CI, et al. Evaluation of complications and neurological deficits with three column spine reconstructions for complex spinal deformity: a retrospective Scoli-risk 1 study. Neurosurg Focus. 2014;36(5):E17.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lenke LG, Fehlings MG, Shaffrey CI, et al. Neurologic outcomes of complex adult spinal deformity surgery: results of the prospective, Multicenter Scoli-RISK-1 study. Spine. 2016;41(3):204–12.

    Article  PubMed  Google Scholar 

  23. MacLennan A. Scoliosis. Br Med J. 1922;2:865–6.

    Google Scholar 

  24. Bradford DS. Vertebral column resection for the treatment of rigid coronal decompensation. Spine. 1997;22(1):1590–9.

    Article  CAS  PubMed  Google Scholar 

  25. Dick J, Boachie-Adjei O, Wilson M. One-stage versus two-stage anterior and posterior spinal reconstruction in adults. Comparison of outcomes including nutritional status, complication rates, hospital costs, and other factors. Spine. 1992;17(Suppl):S310–6.

    Article  CAS  PubMed  Google Scholar 

  26. Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK. Posterior vertebral column resection for severe rigid scoliosis. Spine. 2005;30:1682–7.

    Article  PubMed  Google Scholar 

  27. Voyadzis JM, Gala VC, O’Toole JE, Eichholz KM, Fessler RG. Minimally invasive posterior osteotomies. Neurosurgery. 2008;63(3 Suppl):204–10.

    Article  PubMed  Google Scholar 

  28. Glassman SD, Schwab FJ, Bridwell KH, et al. The selection of operative versus nonoperative treatment in patients with adult scoliosis. Spine. 2007;32:93–7.

    Article  PubMed  Google Scholar 

  29. Lafage R, Schwab F, Challier V, et al. International spine study group. Defining Spino-pelvic alignment thresholds: should operative goals in adult spinal deformity surgery account for age? Spine (Phila Pa 1976). 2016;41(1):62–8.

    Article  Google Scholar 

  30. Gill JB, Levin A, Burd T, et al. Corrective osteotomies in spine surgery. J Bone Joint Surg Am. 2008;90:2509–20.

    Article  PubMed  Google Scholar 

  31. Gum JL, Bridwell KH, Lenke LG, Bumpass DB, Sugrue PA, Karikari IO, Carreon LY. SRS22R appearance domain correlates most with patient satisfaction after adult deformity surgery to the sacrum at 5-year follow-up. Spine (Phila Pa 1976). 2015;40(16):1297–302.

    Article  Google Scholar 

  32. Bridwell K. Decision-making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine. 2006;31(19 Suppl):S171–8.

    Article  PubMed  Google Scholar 

  33. Lafage V, Schwab F, Vira S, et al. Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine. 2011;14(2):184–91.

    Article  PubMed  Google Scholar 

  34. Kim YH, Bridwell KH, Lenke LG, et al. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine. 2007;32(20):2189–97.

    Article  PubMed  Google Scholar 

  35. Gum, JL, Lenke LG, Bumpass D, et al. Does planned staging for posterior-only vertebral column resections in spinal deformity surgery increase perioperative complications? Spine Deform. 2016; 4(2):131–137.

    Google Scholar 

  36. Brown CW, Orme TJ, Richardson HD. The rate of pseudoarthrosis (surgical nonunion) in patients who are smokers and patients who are nonsmokers: a comparison study. Spine. 1986;11:942–3.

    Article  CAS  PubMed  Google Scholar 

  37. West J. Respiratory physiology: the essentials. 6th ed. Philadelphia: Lippincott Williams & Williams; 2000. p. 122.

    Google Scholar 

  38. Bertorini TE. Perisurgical management of patients with neuromuscular disorders. Neurol Clin. 2004;22:293–313.

    Article  PubMed  Google Scholar 

  39. Shin JI, Phan K, Kathari P, et al. Impact of glycemic control on morbidity and mortality in adult idiopathic scoliosis patients undergoing spinal fusion. Clin Spine Surg. 2016: Oct 19. [Epub ahead of print].

    Google Scholar 

  40. Pickhardt PJ, Pooler BD, Lauder T, et al. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med. 2013;158(8):588–95.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Snow R, Granata J, Ruhil AV, et al. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement. J Bone Joint Surg Am. 2014;96(12):e165.

    Article  PubMed  Google Scholar 

  42. Jevsevar DS, Karlin LI. The relationship between preoperative nutritional status and complication after an operation for scoliosis in patients who have cerebral palsy. J Bone Joint Surg Am. 1993;75:880–994.

    Article  CAS  PubMed  Google Scholar 

  43. Tones MJ, Moss ND. The impact of patient self assessment of deformity on HRQL in adults with scoliosis. Scoliosis. 2007;2(1):1–9.

    Article  Google Scholar 

  44. Aurouer N, Obeid I, Gille O, et al. Computerized preoperative planning for correction of sagittal deformity of the spine. Surg Radiol Anat. 2009;31(10):781–92.

    Article  PubMed  Google Scholar 

  45. Rose PS, Bridwell KH, Lenke LG, et al. Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine (Phila Pa 1976). 2009;34(8):785–91.

    Article  Google Scholar 

  46. Akbar M, et al. Use of Surgimap spine in sagittal plane analysis, osteotomy planning, and correction calculation. Neurosurg Clin N Am. 2013;24(2):163–72.

    Article  PubMed  Google Scholar 

  47. Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976). 2009;34(17):E599–606.

    Article  Google Scholar 

  48. Diebo BG, Ferrero E, Lafage R, et al. Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters. Spine (Phila Pa 1976). 2015;40(9):642–9.

    Article  Google Scholar 

  49. Turner JD, Eastlack RK, Mirzadeh Z, et al. Fluctuations in spinal cord perfusion during adult spinal deformity correction identify neurologic changes: proof of concept. World Neurosurg. 2016;85:365.e361–6.

    Article  Google Scholar 

  50. Hart SR, Bordes B, Hart J, et al. Unintended perioperative hypothermia. Ochsner J. 2011;11(3):259–70.

    PubMed  PubMed Central  Google Scholar 

  51. Park J-H, Hyun S-J. Intraoperative neurophysiological monitoring in spinal surgery. World J Clin Cases. 2015;3(9):765–73.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Vitale MG, Skaggs DL, et al. Best practices in intraoperative Neuromonitoring in spine deformity surgery: development of an intraoperative checklist to optimize response. Spine Deform. 2014;2(5):333–9.

    Article  PubMed  Google Scholar 

  53. Biscevic M, Biscevic S, Ljuca F, Smrke BU, et al. Motor evoked potentials in 43 high risk spine deformities. Med Arch. 2014;68(5):345–9.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Saigal R, Clark AJ, Scheer JK, et al. Adult spinal deformity patients recall fewer than 50% of the risks discussed in the informed consent process Preoperatively and the recall rate worsens significantly in the postoperative period. Spine (Phila Pa 1976). 2015;40(14):1079–85.

    Article  Google Scholar 

  55. Apfelbaum JL, Roth S, Connis RT, Domino KB, et al. Practice advisory for perioperative visual loss associated with spine surgery. Anesthesiology. 2012;116(2):274–85.

    Article  Google Scholar 

  56. Emery SE, Daffner SD, France JC, et al. Effect of head position on intraocular pressure during lumbar spine fusion: a randomized, prospective study. J Bone Joint Surg Am. 2015;97(22):1817–23.

    Article  PubMed  Google Scholar 

  57. Daubs MD, Lenke LG, Cheh G, et al. Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine. 2007;32(20):2238–44.

    Article  PubMed  Google Scholar 

  58. Good CR, Auerbach JD, O’Leary PT, et al. Adult spinal deformity. Curr Rev Musculoskelet Med. 2011;4:159–67.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Maruo K, Ha Y, Inoue S, et al. Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity. Spine. 2013;38(23):E1469–76.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of Louisville, Louisville, KY, USA

    Ryan Nazar MD

  2. Norton Leatherman Spine Center, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, USA

    Jeffrey Gum MD, John Dimar MD & Mladen Djurasovic MD

Authors
  1. Ryan Nazar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey Gum MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Dimar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mladen Djurasovic MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mladen Djurasovic MD .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery and Orthopaedics, David Geffen UCLA School of Medicine, Los Angeles, California, USA

    Langston T. Holly

  2. Department of Orthopedics and Rehabilitation, University of Wisconsin UWMF, Madison, Wisconsin, USA

    Paul A. Anderson

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Nazar, R., Gum, J., Dimar, J., Djurasovic, M. (2017). Lumbar Osteotomy Techniques. In: Holly, L., Anderson, P. (eds) Essentials of Spinal Stabilization . Springer, Cham. https://doi.org/10.1007/978-3-319-59713-3_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-59713-3_22

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-59712-6

  • Online ISBN: 978-3-319-59713-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation