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Corrective Spine Osteotomy

  • What is corrective spine osteotomy?

    Spine deformities

    Corrective spine osteotomy (spinal osteotomy) is a general term to describe procedures that correct deformities of the spine.

    A normal spine is naturally curved in 3 places:

    • the cervical spine, or the spine in the neck area, has an inward curve (lordosis)
    • the thoracic spine, or the spine of the upper and mid-back, has an outward curve (kyphosis)
    • the lumbar spine, the spine in the lower back, has an inward curve (lordosis)

    These curves work together to keep the body stable and aligned over the pelvis hence corrective spine osteotomy is performed to correct and restabilise the spine in its correct position.

    The procedure can be divided into:

    • Posterior column osteotomy (PCO)

      Sometimes just called an osteotomy, a PCO removes some bone from the back of the vertebral arch to provide 10 – 20 degrees of correction at one or more levels. A PCO generally helps to correct long, gradual curves of kyphosis which may be caused by conditions such as ankylosing spondylitis. Compared to the other types of spinal osteotomy, a PCO removes the least amount of bone.

    • Pedicle subtraction osteotomy (PSO)

      A PSO removes the vertebral arch, part of the vertebral body and the pedicles that connect the arch to the vertebral body. It produces about 30 degrees of correction and may be performed in one or more vertebrae to treat conditions such as flatback syndrome or sharp, angular kyphosis. A PSO removes more bone than a PCO.

    • Vertebral column resection (VSR)

      A VSR removes the entire vertebrae and replaces it with bone grafts and implants known as cages. While the grafts heal, screws and rods are used to restore spinal stability. It provides around 80 degrees of correction to correct sharp curves and removes the most bone.

    • Spinopelvic fixation

      In spinopelvic fixation, screws, rods or other implements are used to connect the base of the spine to the surrounding bones of the pelvis. This is done to reduce the pressure of bending and rotation which occurs at the junction between the lumbar spine and sacrum.

  • Corrective spine osteotomy may be recommended for deformities of the spine that involve abnormal curvature of the spine, typically kyphosis of 70 degrees or more, or scoliosis of 45 degrees or more.

    Corrective spine osteotomy can help to:

    • Reduce pain
    • Reduce fatigue
    • Allow a person to stand upright
    • Relieve pressure on organs such as the heart and lungs
    • Prevent the deformity from getting worse
  • Preparing for a corrective spine osteotomy

    In preparation for a corrective spine osteotomy, you may be asked to quit smoking as nicotine interferes with bone fusion, a necessary process. You should also inform your doctor of any medications or supplements you may be taking, especially those that may thin the blood. Any allergies to substances, food or medications should also be noted.

    During a corrective spine osteotomy

    During a corrective spine osteotomy, you are placed face-down on the operating table to give the surgeon access to your spine. You are then placed under general anaesthesia so that you remain unconscious throughout the procedure.

    There are some variations between a PCO, PSO and VSR. For example, in a PSO, the operating table is hinged to form an inverted V. In PSO and VSR, your doctor may use spinal cord monitoring techniques such as somato-sensory evoked potentials (SSEP) or motor-evoked potentials (MEP). This helps to monitor your nerve function and spinal safety during the procedure.

    The surgeon will then make an incision over the spine, exposing the spinal column. Screws are then inserted above and below the area where the bone is to be removed.

    The surgeon then removes the necessary bony projections and sections of the bone and vertebrae. Next, the surgeon aligns the vertebrae, using implants and inserting rods into the screws to hold the spine in position while it heals. Then, a bone graft or transplanted bone is applied, which will fuse with the vertebrae, providing spinal stability. Finally, the incision is then sutured in layers and the wound dressed.

    After a corrective spine osteotomy

    After a spinal osteotomy, depending on which procedure you have undergone, a hospital stay of up to one week may be expected. During this time, post-surgical pain can be managed with medication.

    You should speak to your doctor about how soon you can expect to resume walking and normal activity.

    Recovery period for a corrective spine osteotomy

    Recovery period will vary based on your procedure and you may need to come back for X-rays to monitor how well the bone is fusing.

    Physiotherapy will aid in your recovery and you should follow your doctors’ advice on when you can safely take part in vigorous or strenuous activities.

    Risks associated with a spinal osteotomy

    • Bleeding
    • Infection
    • Nerve damage
    • Damage to the spinal column
  • Mount Elizabeth Hospitals have over 40 years’ experience in helping patients to improve their orthopaedic health.

    If you have problems such as stooped posture, visible misalignment of the shoulder, spine or hip, or the inability to stand upright, these may be a sign of spine deformities.

    Severe deformities may require surgical intervention such as corrective spine osteotomy. As spinal deformities can worsen if left untreated, it’s important to get a medical diagnosis and seek the appropriate treatment.

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