Osteotomy

What is an Osteotomy?

A spinal osteotomy is a surgical procedure used to correct certain deformities of the adult or pediatric spine.

Most procedures that treat spinal deformity are technically types of osteotomy. These include the posterior column osteotomy (PCO), the pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR).

This page will focus on the posterior column osteotomy. Follow the links above for separate information pages on the other deformity correction procedures. For a brief overview of spinal deformity and a comparison of all three procedures, see the deformity correction overview page.

When is this Procedure Performed?

Proper spinal alignment is important for pain-free functioning of the spine. The gentle lordosis, or sway-back, of the lower spine and the neck are balanced by a gentle kyphosis, or hunch-back, in the upper spine. These curves work in harmony to keep the body’s center of gravity aligned over the pelvis.

A loss of lordosis in the lower spine (flatback syndrome) or an excess of kyphosis in the upper spine (hyperkyphosis) puts the spine out of alignment. This type of misalignment is called sagittal imbalance. It can cause stooping, pain, fatigue, difficulty meeting the gaze of other people, and/or compression of organs like the heart and lungs.

During a PCO, a surgeon removes a wedge-shaped section of bones at the back of the spine. Closing the wedge adds lordosis (sway-back) or reduces kyphosis (hunch-back).

The disc in front of the removed bone must accommodate the new position of the bones, so a PCO requires a flexible disc between target vertebrae. A surgeon evaluates spinal flexibility during the formulation of a treatment plan. If the discs cannot accommodate a PCO, other surgical options are available.

Types of sagittal imbalance commonly treated with an posterior column osteotomy include Scheuermann kyphosis and some cases of ankylosing spondylitis. In general, PCOs are well-suited for correcting the curve of a long, gradual deformity.

A single PCO usually provides 10-20 degrees of correction. But PCOs are often performed at multiple spinal levels, depending on where and how much correction is needed. A series of PCOs can “add up” to the desired correction.

How is this Procedure Performed?

A PCO is performed under general anesthesia, which means the patient is unconscious. After the patient is unconscious, he or she is placed face-down on an operating table.

The surgeon makes an incision over the spine and exposes the bones of the spinal column. Then the surgeon inserts screws into the vertebrae above and below the area of bone removal. The heads of the screws are designed to accept rods. At the end of the surgery, the surgeon will insert rods that immobilize the spine while it heals in its new position.

Next, the surgeon removes bony projections called processes that extend from the back of the vertebrae. Then the surgeon removes sections of bone called the lamina at the back of a vertebra, and removes portions of the facet joints between the vertebrae that will be realigned.

Then it is time to realign the vertebrae. The neurosurgeon manipulates the patient’s spine into a new position, using implants to obtain the desired correction.

Once the vertebrae are realigned, the surgeon will insert rods into the screws that were placed at the beginning of surgery. The rods hold the bones of the spine in the exact position achieved during surgery while they heal. Then the surgeon typically applies bone graft, or transplanted bone, over the vertebrae. The bone graft will fuse, or grow permanently together, with the vertebrae, forming one solid bone. Achieving good bony fusion is crucial for long-term spinal stability.

Finally, the incision is closed in layers and the wound is dressed with a gauze bandage.

How Should I Prepare for this Procedure?

If you use tobacco products, it is very important that you speak with your neurosurgeon about quitting. Nicotine interferes with the body’s ability to achieve good bony fusion. Quitting tobacco products is an important step in achieving a good surgical outcome.

If you have any questions about the goals of surgery, the risks, the procedure itself, or the recovery, bring them up with your or your child’s neurosurgeon. The neurosurgeons at The Spine Hospital at the Neurological Institute of New York want to make sure you understand these and any other issues related to the surgery. You may wish to keep a list of questions as you think of them, and bring the list to your appointment.

Make sure to tell your doctor about any current medications or supplements being taken, especially medications that can thin the blood such as aspirin. Your doctor may recommend you stop taking these medications before your procedure. To make it easier, write all medications down before the day of surgery and show the list to your doctor.

Be sure to tell your doctor if you or your child have an allergy to any medications, food, or latex (some surgical gloves are made of latex).

On the day of surgery, remove any nail polish or acrylic nails, do not wear makeup and remove all jewelry. If staying overnight, bring items that may be needed, such as a toothbrush, toothpaste, and dentures. You will be given an ID bracelet. It will include your name, birthdate, and surgeon’s name.

What Should I Expect After the Procedure?

How long will I stay in the hospital?
Patients usually stay in the hospital 5-7 days.

Will I need to take any special medications?
Discomfort after surgery will be treated with pain medication.

Will I need to wear a collar or brace?
In some cases, particularly if the osteotomy was performed in the neck, the surgeon may prescribe a collar to be worn after surgery.

When can I resume exercise?
Patients can usually begin walking as soon as they are able. More vigorous exercise must be postponed until later in the healing process.

Will I need rehabilitation or physical therapy?
Yes, physical therapy will be part of your recovery plan.

Will I have any long-term limitations due to osteotomy?
There may be some decreased mobility due to fusion. Discuss with your surgeon any long-term limitations that may be associated with your particular procedure.

Preparing for Your Appointment

At The Spine Hospital at the Neurological Institute of New York, Drs. Michael G. Kaiser, Peter D. Angevine, Christopher E. Mandigo, Alexander Tuchman and Richard C.E. Anderson (Pediatric) are experts on the posterior column osteotomy and other deformity correction procedures.

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