The posterior column osteotomy (PCO) is an adjunct technique for obtaining deformity correction during posterior spine fusion procedures. Full disarticulation of the posterior spinal column, including bony elements (namely the lamina and facet joints) and ligamentous complex is described as a PCO. This technique was originally described to allow for shortening of the posterior column during correction of excessive thoracic kyphosis; however, its indications have since been expanded to other spine deformities such as adolescent idiopathic scoliosis (AIS). Its expanded role in deformity surgery has been met with controversy: proponents tout increased flexibility and better spinal correction in three planes, while detractors cite lack of ostensible clinical benefit and potential for more complications. Differences in surgical technique are also prevalent. In this manuscript, we review the surgical technique of PCOs, including the traditional PCO as well as a modified posterior column release (PCR). Additionally, the controversy over when this technique should be utilized is further explored through summation of current literature on PCO outcomes. Key Concepts• The indications for posterior column osteotomies in pediatric spine deformity surgery are frequently debated, with the risk-benefit profile weighed differently among surgeons.• Proponents of PCO use in scoliosis assert improved flexibility and correction of spinal deformity in three dimensions, in particular the ability to better restore thoracic kyphosis.• Most studies acknowledge that there is an increased risk of a neuromonitoring alert when PCOs are performed, though a significant difference in postoperative deficits has not been described.

The role of the posterior column osteotomy (PCO) in the treatment of pediatric spinal deformity is controversial. Differences in perceived clinical benefit and associated risk exist between surgeons along with differences in technique and indications. In this panel discussion, four experienced spine surgeons provide insight into their use of PCOs for the surgical treatment of scoliosis.