Lumbar Posterior Column Osteotomy and Correction
Mathew Cyriac
John M. Rhee
Illustrative Case
A 47-year-old man who underwent several previous surgeries elsewhere resulting in a solid fusion from L3 to S1 in hypolordosis. He complained of low back and bilateral leg pain thought to be related to adjacent segment stenosis at L2-3 (Figures 28-1 and 28-2).
Indications/Considerations
Posterior column osteotomy (PCO) is a chevron resection of the lamina, ligamentum flavum, facets, and pars. The pars and the facets are removed such that the exiting roots are completely freed up from the caudal surface of the pedicle above to the superior aspect of the pedicle below. By compressing the posterior elements and shortening the posterior column, lordosis can be increased.
The primary indication for PCO is to increase lordosis. It can be done through previously fused or unfused segments.
It can be a posterior-only procedure (as in Figure 28-3) or performed in combination with an anterior release or osteoclasis of a fused disk space (eg, in ankylosing spondylitis).
When associated with anterior release or osteoclasis, significantly more correction can be achieved.
However, doing so will lengthen the anterior column and potentially stretch the anterior great vessels.
When combined with an anterior release, the spine may become highly unstable. Therefore, rigid fixation is needed to prevent instrumentation failure.
More modest amounts of lordosis will be achieved when the disk is left intact, and the posterior column is shortened without lengthening the anterior column.Stay updated, free articles. Join our Telegram channel
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