Posterior Column Osteotomies in Adolescent Idiopathic Scoliosis

Abstract

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.

Three-stage correction of severe idiopathic scoliosis with limited skeletal traction during a humanitarian surgical mission: illustrative case

“…This technique has been described in detail elsewhere. 8 The periapical levels of T9 and T10 were not instrumented because the spinal cord was compressed against the concave pedicle at each of these levels, posing significant risk of IONM signal loss and subsequent neurological deficit. Furthermore, the ribs were prominent over the curve convexity at these levels, making it difficult to achieve the optimal pedicle screw trajectory without performing a thoracoplasty.…”