Indications for Spinal Osteotomy

Abstract

Spinal osteotomy can be undertaken in a pediatric or adult patient who presents with spinal deformity in one or more planes and requires release or destabilizing procedures (osteotomies/resection) to achieve the desired correction [1–3]. It can be performed from the posterior or anterior approach or as combined anterior/posterior procedures in a single or staged fashion [4, 5]. Common indications include spinal decompensation or malalignment, progressive deformity, pseudarthrosis in a previously fused spine, and crankshaft occurring in pediatric patient. Posterior only osteotomy procedures have become popular techniques and can be limited to the posterior elements as in the Smith-Petersen, as a three-column osteotomy technique as in pedicle subtraction osteotomy or posterior vertebral column resection [6, 7]. The need for combined anterior posterior procedures is dictated by whether anterior instrumentation needs to be removed prior to posterior approach or if anterior insufficiency exists after a posterior osteotomy procedure and anterior fusion is needed to optimize the fusion. Cases illustrative of the different indications for spinal osteotomy are presented in this chapter to elucidate the rationale for each osteotomy technique and why each is suited for the particular deformity presented therein.