Corrective Spine Osteotomy

What is corrective spine osteotomy?

Corrective spine osteotomy is a surgical procedure to correct the abnormal curvature of your spine. The procedure is done to shorten or lengthen some of the bones in your spine and fuse them together in the correct alignment.

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 your body stable and aligned over the pelvis. Corrective osteotomy corrects and stabilises the spine in its right position.

Types of treatment

Corrective spine osteotomy can be divided into different procedures. Your doctor will recommend the most suitable procedure to improve your condition:

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 an outward curve (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 outward curves (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.

Why do you need corrective spine osteotomy?

Your doctor may recommend corrective spine osteotomy if the abnormal curvature of your spine is more severe. This could mean a kyphosis (hunching) of 70 degrees or more or scoliosis (sideways curve) of 45 degrees or more.

Corrective spine osteotomy can help to:

• Reduce pain
• Reduce fatigue as your upper body will be supported by a straighter spine
• Correct your posture and allow you to stand upright, improving your physical appearance
• Relieve pressure on organs such as the heart and lungs
• Prevent the deformity from getting worse

What are the risks and complications of corrective spine osteotomy?

The risks associated with spinal osteotomy depends on your overall health and may include:

• Bleeding
• Infection
• Nerve damage
• Damage to the spinal column

How do you prepare for corrective spine osteotomy?

Your doctor may ask you to quit smoking, as nicotine interferes with bone fusion during your recovery.

You should also inform your doctor of any medications or supplements you may be taking, especially those that may thin the blood. Let your doctor know if you have any allergies to substances, food or medications.

What can you expect for a corrective spine osteotomy?

Corrective spine osteotomy is performed under general anaesthesia.

Before the procedure

You will lie face down on the operating table to allow the surgeon to operate on your spine. You will receive general anaesthesia to block the pain and keep you asleep during the procedure.

Note: If you are doing a pedicle subtraction osteotomy (PSO), the operating table will be hinged to form an inverted “V”.

During the procedure

Your surgeon will:

1. Make an incision over the spine, exposing the spinal column
2. Insert screws above and below the area where the bone is to be removed
3. Remove the necessary bony projections and sections of the bone and vertebrae (bones that form the spinal column)
4. Align the vertebrae, using implants and inserting rods into the screws to hold the spine in position while it heals
5. Apply a bone graft or transplanted bone that will fuse with the vertebrae to stabilise your spine
6. Close up the incision

Note: In a pedicle subtraction osteotomy (PSO) and vertebral column resection (VSR), your doctor may use spinal cord monitoring techniques such as somato-sensory evoked potentials or motor-evoked potentials to monitor your nerve function and spinal safety during the procedure.

Care and recovery after corrective spine osteotomy

Depending on the type of procedure received, you may need to stay in the hospital for up to 1 week. During this time, your doctor will prescribe medication to relieve any post-surgical pain.

Your doctor may schedule you for X-ray examinations to monitor how well the bone is fusing.

Discuss with your doctor when you can expect to resume walking and normal activity. Follow your doctor's advice on when you can safely take part in vigorous or strenuous activities.

Your doctor may also recommend physiotherapy to help you recover faster.