Osteotomy of the Spine
Our spine is made up of small bones called vertebrae that are structurally balanced for optimal flexibility and support of the body's weight. The spine is divided into three segments: the lumbar spine, the thoracic spine, and the cervical spine. The normal spine is curved to form an S-shape," but when those curves are exaggerated, misaligned, or displaced, they are considered spinal deformities. The common signs of spine deformities are C-shaped curvature, protruding shoulder blades, and uneven shoulders and hips.
Moderate and flexible spine deformities can be corrected by non-surgical methods like physical therapy and medications. However, a spinal osteotomy is needed for severely rigid and fixed spine deformities.
What is a spine osteotomy?
A spinal osteotomy is a surgical procedure used to correct certain deformities of the spine. In this procedure, a section of the spinal bone is cut and removed for correction of spinal alignment. Spine osteotomy is also considered a cosmetic surgery, especially in young patients, to improve their cosmesis. Spine osteotomies can be broadly divided into three main types: posterior column osteotomies (PCO), pedicle subtraction osteotomies (PSO), and vertebral column resections (VCR).
When is a spine osteotomy recommended?
Spine osteotomies are usually recommended to correct the following conditions:
- Severely deformed spine leading to nerve compression
- Fixed or rigid spinal bone
- Congenital deformity (deformity present at birth)
- Age-related degeneration of spinal bones
- Tumors or infections that cause spinal deformity
In addition to the above conditions, a spine osteotomy is recommended when nonsurgical treatments do not relieve symptoms and the deformity is getting worse over time.
What are the pre-procedure care for the surgery?
Before proceeding with surgery, you will have an appointment with the surgeon to prepare you physically and psychologically for the surgery. The pre-procedure preparations include:
- Stop certain medications: You will be asked to stop certain medications like non-steroidal anti-inflammatory medications (NSAIDs), anti-coagulants, diuretics, etc., which may increase the risk of bleeding or other complications during surgery.
- Quit smoking: You should stop smoking before the surgery as it is extremely harmful for spine health. Nicotine will prolong the potential for bone healing and surgical outcomes.
- Health check-ups: It is important to evaluate your health status to ensure that you are healthy enough to undergo the surgery.
- Assistance: You will be asked to arrange for someone to drive you back home and to assist you at home during the recovery period.
In addition to the above preparations, you will be asked not to eat or drink anything after midnight before your surgery.
How is the surgery performed?
After hospital admission, you will be taken to the preoperative area, where the healthcare team will review your health. An intravenous line (IV) will be started in your arm, and antibiotics will be given before, during, and after surgery. After shifting to the operating room, the anesthesiologist will inject anesthesia through the IV line.
Smith-Petersen Osteotomy (SPO)
SPO is recommended for those patients who need relatively small corrections in the alignment of their spinal bones. The procedure corrects the kyphotic spine condition (excessive outward curve of the spine) by shortening the posterior column.
Procedure: A section of bone is removed from the back of the spine, and thereby the spine will lean more towards the back. Both the posterior ligaments and the facet joints (joints between two adjacent vertebrae) are removed from that area. The spinal correction is performed through the vertebral disc space.
For correcting a condition like lordosis (inward curving of the lower back), this method must be performed at one or multiple locations along the spine.
Pedicle Subtraction Osteotomy (PSO)
PSO is recommended for patients with moderate to severe spinal deformities. This method involves all three posterior, middle, and anterior columns of the spine.
Procedure: The posterior ligament and facet joints are removed, similar to a SPO. In addition to this, a triangular wedge through the pedicles (a short and thick bone that provides protection for the spinal cord and nerves at the side) is also removed, and the posterior spine is shortened.
The PSO technique is ideal for patients with severe sagittal (longitudinal plate) imbalance, and it provides more correction of lordosis than SPO.
Vertebral Column Resection Osteotomy (VCR)
A VCR osteotomy is recommended for severe spinal deformities that cannot be corrected by other methods. The technique involves the complete removal of a single or multiple vertebral bodies. The VCR osteotomy allows the maximum correction that can be achieved with any spinal osteotomy.
As the procedure requires the complete removal of bones, spinal fusion is also performed along with it. It involves the use of a structural autograft, structural allograft, or metal cage.
Major spinal deformities like kyphosis, scoliosis (a side-to-side curve), and lordosis can be corrected by a VCR osteotomy.
What is the post-procedure care?
After a spine osteotomy, you may require a hospital stay of 5-7 days. You may experience pain in the first few days after surgery, which is usually controlled by pain medications. If you have undergone spine fusion, then your spine should be kept in proper alignment, for which you will be taught how to sit, stand, sleep, and walk properly. Physiotherapy will begin the day after the surgery, as it will help the patient build strength and flexibility in the spinal column.
Prior to discharge, you may be given some instructions about medications and rehabilitation procedures at home. A physiotherapist will provide a home exercise program to improve the strength and function of the spinal column. Activities like lifting heavy objects, driving, or any strenuous household activities must be restricted for several weeks. The recovery time depends on the extent of surgery, other medical conditions, and how closely the instructions are followed.
Outlook
Spine osteotomy is recommended for patients whose deformity is progressing and non-surgical methods are ineffective. It aims to correct the deformity of the spinal curve with the goal of relieving pain and other associated symptoms. Spine osteotomies also prevent the curvature from worsening in the future. Over the past decades, osteotomies have been widely used in spine corrections and have had successful outcomes. A spine osteotomy procedure requires fewer hospital stays compared to other spine surgeries.