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Array of posterior osteotomies help achieve deformity-correction goals

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PHOENIX — Despite a few limitations to its use, the posterior osteotomy can provide surgeons with a variety of methods to correct spinal deformity that is sagittal, coronal or both, according to a presenter at the Spine Summit 2015: CNS/AANS Section on Disorders of the Spine & Peripheral Nerves Annual Meeting, here.

Sigurd H. Berven, MD, of the University of California, San Francisco, discussed the kinds of adult deformity cases in which he prefers posterior osteotomy over an anterior approach to achieve the spinal correction a patient needs.

“There is a lot of variability in how we approach these patients, and certainly anterior vs. posterior approaches represent part of that variability,” Berven said.

Sigurd H. Berven

Berven encouraged surgeons to think about the goals of realignment of a deformed spine, not only at the segmental level, but also at the regional and global levels of the spine.

Among the types of posterior osteotomies he discussed was the pedicle subtraction osteotomy, which addresses segmental realignment when there is sharp, focal deformity, and the Ponte osteotomy for patients with flexible thoracic deformity who present with kyphotic deformity.

“In patients with more rigid deformity, the Smith-Petersen osteotomy becomes appropriate,” Berven said.

The Smith-Petersen procedure is also indicated for patients with prior fusions that need to be taken down, he said.

For transpedicular or three-column procedures, Berven discussed an “eggshell” procedure that involves decancellation, originally described by Charles F. Heinig, MD.

“Something I commonly use in my surgical technique is really eggshelling that bone. I can minimize blood loss with that,” he said.

Increased blood loss, deep infection and reduced lower-extremity motor function scores are among the complications that may be associated with more involved multi-column osteotomies, so surgeons need to guard against those risks, according to Berven.

However, “in many cases, we can get very effective or as effective deformity correction with a posterior-only approach when we are using these osteotomies,” he said. – by Susan M. Rapp

Reference:

Berven SH. SRS Co-sponsored session — spine deformity: Osteotomies. Presented at: Spine Summit 2015: CNS/AANS Section on Disorders of the Spine & Peripheral Nerves Annual Meeting; March 4-7, 2015; Phoenix.

Disclosure: Berven receives honoraria from Biomet, DePuy Spine, Globus Spine, Medtronic and Stryker Spine. He has ownership interest in Providence Medical and Simpirica Spine and receives royalties from Medtronic.