Spinal Osteotomy

Spinal osteotomy is used to treat various conditions, including:

1. Kyphosis: An excessive forward curvature of the spine, often leading to a hunchback appearance.
2. Scoliosis: A lateral curvature of the spine that can cause a significant imbalance and discomfort.
3. Flatback Syndrome: A condition where the normal lumbar curvature is lost, causing difficulty in standing upright.
4. Ankylosing Spondylitis: A form of arthritis that causes chronic inflammation and can lead to the fusion of spinal vertebrae.
5. Post-traumatic Deformity: Deformities that occur following spinal fractures or injuries.

Several types of spinal osteotomy procedures can be performed depending on the location and severity of the deformity. Several authors such as Schwab, et al, have described detailed classification systems for osteotomy types.

1. Smith-Petersen Osteotomy (SPO): Involves removing a wedge of bone from the posterior elements of the spine. This is typically used for less severe deformities.
2. Pedicle Subtraction Osteotomy (PSO): Involves removing a triangular wedge of bone from a vertebra and then realigning the spine. This is used for more significant deformities.
3. Vertebral Column Resection (VCR): Involves removing one or more entire vertebrae and then realigning the spine. This is reserved for severe deformities that cannot be corrected by other methods.

The spinal osteotomy procedure involves significant preoperative planning by Dr. Colman including detailed imaging studies, such as X-rays, CT scans, and MRIs. In addition, all medical conditions must be well managed. The pre-operative team will ensure proper medical management in adult and pediatric patients.

A surgical incision is made over the area of the spine to be corrected. Dr. Colman will expose the spine, place stabilization hardware above and below the osteotomy site, and decompress the nerves in the area. He will then remove the appropriate wedge of bone to achieve the desired correction at the appropriate spinal level. Then the spine is carefully realigned to the correct position, and metal rods, screws and plates are used to stabilize the spine during healing.

The success rates of spinal osteotomy are generally high, but outcomes can vary based on several factors:

1. More severe deformities may have a more complex recovery.
2. Overall health and the presence of other medical conditions can affect recovery.
3. The expertise and experience of the surgeon play a crucial role in the success of the procedure.
4. The extent of osteotomy affects outcomes, with more complications and longer recovery observed with PSO and VCR osteotomies.

Most patients experience significant improvements in pain, posture, and overall function. However, as with any major surgery, there are risks, including infection, blood loss, nerve damage, and complications related to anesthesia.

Spinal osteotomy is a powerful tool for correcting severe spinal deformities. While the procedure and recovery can be demanding, the potential for improved quality of life makes it a worthwhile option for many patients suffering from debilitating spinal conditions.