What is a spinal osteotomy?
A spinal osteotomy is a surgical procedure used to correct deformities in the spine. Here, bone is removed from the back of the vertebral arch to correct long, gradual curves of kyphosis like those produced by Scheuermann's kyphosis or ankylosing spondylitis.
The majority of procedures that treat spinal deformities are types of osteotomy. These include posterior column osteotomy (PCO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR).
When is a spinal osteotomy performed?
Proper spinal alignment is important for pain-free functioning of the spine. The slight lordosis of the neck and lumbar (lower) spine are balanced by a slight kyphosis of the thoracic (upper) spine. These curves work in harmony to keep the body's centre of gravity aligned over the pelvis.
A reduction in lordosis in the lower region of the spine (also known as flatback syndrome) or an excess in kyphosis in the upper region of the spine (known as hyperkyphosis) results in spinal misalignment. This is called sagittal imbalance and can cause fatigue, pain and compression of organs such as the heart and lungs.
During a spinal osteotomy, the surgeon removes a wedge-shaped section of bone from the back of the spine. Closing this wedge either adds lordosis or reduces kyphosis. This disc in front of the removed bone must accommodate the new position of the bones, so a spinal osteotomy requires a flexible disc between the target vertebrae. A surgeon assesses spinal flexibility during the creation of a treatment plan. If the discs cannot support a spinal osteotomy, other surgical options may be considered instead.
A PCO usually provides a patient with 10-20 degrees of correction, but this procedure is often performed at multiple spinal levels. Depending on where and how much correction is needed, a series of PCOs can 'add up' to the desired correction.
How is a spinal osteotomy performed?
A spinal osteotomy is conducted under general anaesthetic, meaning the patient is unconscious. They are placed face-down on the operating table, where the surgeon makes an incision over the spine to expose the bones in the spinal column. The surgeon then places screws into the vertebrae above and below the area from which the bone is to be removed. The heads of the screws are designed to hold rods. At the end of the surgery, the surgeon will insert rods that immobilise the spine while it heals in its new position.
Next, the surgeon removes bony projections that extend from the back of the vertebrae. The surgeon then removes sections of bone called the lamina at the back of the vertebrae and portions of facet joints between the vertebrae that will be realigned.
It is then time to realign the vertebrae. Here, the surgeon manipulates the patient's spine into a new position, using implants to obtain the desired correction. Once alignment has been achieved, the surgeon inserts rods into the screws that were placed at the beginning of the surgery. The role of the rods is to hold the bones of the spine in the position achieved during the surgery while they heal. After this, the surgeon will apply bone graft or transplanted bone over the vertebrae. The bone graft will fuse with the vertebrae, forming one solid bone. Achieving good bone fusion is vital for long-term stability.
What to expect after a spinal osteotomy
Once the spinal osteotomy procedure has been successfully completed, you may have a number of questions. Let's answer several common post-osteotomy questions right now:
How long will I have to stay in the hospital?
Patients typically stay in the hospital for 5-7 days after their spinal osteotomy procedure.
Will I need to wear a brace or collar?
Sometimes surgeons may prescribe a brace or collar if the osteotomy was performed in the neck. If performed on the spine, this is less common.
Will I have to take any medication?
If any discomfort is experienced after the spinal osteotomy, pain relief medication may be prescribed.
How long before I can exercise again?
You can begin to walk as soon as you're comfortable to do so. More rigorous forms of exercise will have to wait until later on in the healing process.
Will I require any form of rehab or physical therapy?
Yes, physical therapy will be a part of your recovery process.
Will spinal osteotomy cause any long-term limitations?
As a result of your fusion, you may experience some decreased mobility; however, this all depends on your particular procedure.
How can Scoliosis SOS help?
If you have undergone a spinal osteotomy procedure and your doctor recommends participating in physical therapy as part of your recovery plan, we at the Scoliosis SOS Clinic can help!
We offer world-renowned physical therapy that helps to increase the spine's range of motion and strengthen the muscles in your back, helping you to resume regular activities as soon as possible. Our ScolioGold method combines the well-known Schroth method with other proven therapy techniques to help speed up your spinal osteotomy recovery.
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