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STATE OF THE ART REVIEW

State of the art review: Vertebral Osteotomies for the management of Spinal Deformity Alex S. Ha1 · Meghan Cerpa1   · Lawrence G. Lenke1 Received: 12 December 2019 / Accepted: 18 May 2020 © Scoliosis Research Society 2020

Abstract Spinal deformity is a complex condition caused by various etiologies (degenerative, neuromuscular, congenital, developmental, traumatic, neoplastic, idiopathic) leading to clinical deformity, axial back pain, and neurologic deficits. Patients presenting with severe deformities require vertebral osteotomies to achieve the necessary curve correction for radiographic and clinical improvement. The three major vertebral osteotomy techniques commonly used at this time are the posterior column osteotomy (PCO), pedicle subtraction osteotomy (PSO), and vertebral column resection (VCR). The different vertebral osteotomies have unique merits and pitfalls that need to be addressed during preoperative planning to achieve maximum benefit while limiting or avoiding possible complications. The more difficult vertebral osteotomies have a steeper learning curve and requires extensive pre, intra and postoperative management of the patient. This review will aim to discuss the indications, surgical techniques, and clinical outcomes for each of these different vertebral osteotomy techniques with illustrative cases. Keywords  Vertebral osteotomies · Spinal deformity · Spine surgery · 3-Column osteotomies

Introduction Spinal deformity is a complex condition involving both sagittal and coronal plane malalignment that affects up to 32% of the population and can cause significant impairment [1]. Often, spinal deformity causes progressive asymmetric degeneration of the spinal elements leading to clinical deformity, axial back pain, and neurologic deficits [2]. These deformities are caused by various different etiologies (degenerative, neuromuscular, congenital, developmental, traumatic, neoplastic, idiopathic) and have an impact on children, adolescents, adults, as well as the elderly. Goals of operative treatment include restoring proper spinal alignment, relieving pain, addressing neurologic dysfunction, and preventing worsening deformity. With the advent of pedicle screw and rod constructs, along with an improved understanding of spinal anatomy, intricate posterior-only vertebral osteotomy techniques have gained increased popularity

* Meghan Cerpa [email protected] 1



The Och Spine Hospital, NewYork-Presbyterian/Columbia University Medical Center, 5141 Broadway, 3 Field West‑022, New York, NY 10034, USA

for the correction of coronal and sagittal spine deformity in recent years [3]. With recent advancements in medicine and technology, the longevity of the global population is increasing creating a burgeoning older population with changes in what one accepts as satisfactory quality of life compared to the past. The advances in surgical instrumentation and curve correction techniques are frequently employed during spine surgery to improve spinal alignment, although patients wit