Wednesday, September 16, 2020

 

Spine Osteotomies                             

 

So your surgeon want to “cut” your spine….that just doesn’t sound good, does it?

Well what are they talking about “cutting” the bone of your spine? To surgeons it is call an “osteotomy” which, if you break the word down to its latin roots, means bone (for “osteo”) and cutting part of the body (for “otomy”). 

The first spine osteotomy was done by an Italian surgeon, Alberto Ponte, in the mid-1970s for increased kyphosis or rounding of the back.  Dr. Ponte wanted to loosen the spine to get better correction of spine deformity, so he removed bone and soft tissue between vertebra, done all from the back side. Over the last 40+ years these osteotomies have been used around the world for all types of spine deformity.

So how does your surgeon do these osteotomies?

STEP 1: The goal is to completely remove all bone and soft tissues between the vertebra. So the first step is to remove some bone (below shaded area) from the upper vertebra.


 

STEP 2: Once that is done the soft tissue in midline, call th
e ligamentum flavum (the vertical white tissue which looks like vertical blinds) is carefully removed.


 

STEP3: Next the bone on the lower vertebra is removed….




This creates a complete gap between the vertebra (see below picture at orange shaded area)

 

 

 

 


STEP 4: The pedicle screws are then placed….and the spine is ready to be corrected to a better position

 


 

***So is this a safe procedure to do the spine?  In the below research study we analyzed the complications of doing spine osteotomies in pediatric and adolescent patients at Washington University. 


484 osteotomies in 142 patients were studied and there were 0.4% frequency of complications (2 patients had dural tears that were repaired in surgery).  So yes, these can be very safe procedures to perform.

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This is a good reference:

https://surgeryreference.aofoundation.org/spine/deformities/adolescent-idiopathic-scoliosis/basic-technique/large-curves#posterior-column-osteotomy-pco-







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