A Review of Indications, Surgical Technique, and Outcomes for the Cervical Pedicle Subtraction Osteotomy

Abstract

Cervical spine deformity is a debilitating condition that can be challenging to treat. For patients with fixed, focal, kyphotic deformities near the cervicothoracic junction, a pedicle subtraction osteotomy (PSO) can be considered. Classifying a given cervical spine deformity and quantifying the mismatch between current and desired alignment are critical steps in determining whether a PSO should be done. It is also important to understand the relative contraindications for a cervical PSO and the radiographic and patient-reported outcomes associated with the procedure. Here, we review these topics and the details of our surgical technique and postoperative considerations. Specific nuances of the setup, exposure/approach, osteotomy, closure, and postoperative protocol are highlighted. A surgical video is also included (Video 1). Our aim is to provide a conceptual framework for understanding when a cervical PSO should be considered, how it can be performed effectively, and the outcomes that can be expected. Cervical spine deformity (CSD) is a debilitating condition that can be challenging to treat. Pathologic kyphosis of the cervical spine can inhibit forward gaze and swallowing, while placing the paraspinal muscles under incredible strain that leads to fatigue and serious disability. This is corroborated by the fact that inadequate cervical lordosis (CL), high C2-C7 sagittal vertical axis (SVA), and an unfavorable T1 slope/CL mismatch have been correlated with high Neck Disability Index (NDI) scores. 1 Background InformationThe surgical management of cervical deformity includes an anterior cervical diskectomy and fusion, anterior cervical corpectomy and fusion, anterior osteotomy, posterior cervical fusion with/without decompression, posterior cervical Smith-Peterson osteotomy (SPO), cervical pedicle subtraction osteotomy (PSO), and some combination of the above techniques. For patients

Cervical alignment and clinical outcome of anterior cervical discectomy and fusion vs. anterior cervical corpectomy and fusion in local kyphotic cervical spondylotic myelopathy

“…Cervical local kyphosis is often seen and potentially debilitating condition [ 3 ]. Nearly half a century, the anterior approach was widely applied for cervical degenerative disease due to radiculopathy and myelopathy [ 4 ].…”

“…The surgical goals are still spinal cord decompression, local kyphotic correction, and spinal stabilization with solid bony fusion. CLK is a common degenerative disorder with a potentially debilitating condition, which is treated intractably [ 3 ].…”

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

“…In some patients with CSM, cervical kyphosis may develop because of the changes of intervertebral height and sagittal lordotic alignment, as well as progressive degeneration of the discs and facet joints. Cervical kyphosis is a common but potentially debilitating condition that can be challenging to treat ( Sivaganesan and Kim, 2022 ). Although non-surgical treatments may have some short-term benefits in improving this disease, surgery remained to be pivotal to decompression of the spinal cord and correction of kyphosis using either anterior approach or posterior approach.…”