Tips and Pearls in Spinal Osteotomy

Background and Aim: Spinal osteotomy is a general term for techniques applied to correct spinal deformity. The aims of osteotomy are to create a normal range of spine curvature, pain relief, and to improve quality of life. In the cases where spinal deformities cannot be corrected using instrumentation alone or by facet or ligament release, osteotomy is indicated. In spinal osteotomies, spinal alignment is corrected by removing part of the spinal bone. Osteotomies can be performed as anteroposterior or posterior-only procedures with a greater predilection for posterior-only procedures. Different types of osteotomy are available, including the Smith-Petersen osteotomy (SPO), Ponte osteotomy (PO), pedicle subtraction osteotomy (PSO), corner osteotomy (CO), or bone-disc-bone osteotomy (BDBO), vertebral column decancellation (VCD) and vertebral column resection (VCR). Methods and Materials/Patients: In this narrative study, to provide up-to-date information, we precisely reviewed articles in the osteotomies context. Using the keywords spinal osteotomy, spinal deformity, Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), vertebral column resection (VCR), vertebral column decancellation (VCD), Ponte osteotomy (PO), corner osteotomy (CO), all the relevant articles were retrieved from PubMed, Google Scholar, Medline, and critically reviewed and analyzed. Results: In the spine surgery, osteotomy is performed to correct the deformity in uncorrectable spinal deformity. The suitable type of osteotomy is selected based on the etiology, type, and apex of deformity, surgeon's experience, availability of blood and bleeding control agents, and availability of intensive care. A wider acceptance of posterior-only procedures exists in osteotomy. Conclusion: In spinal deformity surgery, more degrees of correction are needed for better cosmetic results, and for this purpose, spinal osteotomy has a central role. For this reason, all spine surgeons should be familiar with these osteotomy techniques.