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A deformity is simply a variation in the shape of a structure when compared to the typical shape of that structure. A spinal deformity is produced by any combination of curvature and twisting of the spine. Types of Deformity Correction
The main correction and stabilization procedures are osteotomy, pedicle subtraction osteotomy, vertebral column resection, and spinopelvic fixation. These procedures vary in the amount of bone they remove and in the amount of correction they provide.The osteotomy (sometimes called a posterior column osteotomy, or PCO) removes some bone from the back of the vertebral arch. It produces about 10-20 degrees of correction at each level and it can be performed at several levels. Therefore it is often used to correct long, gradual curves of kyphosis, like ones that may be produced by Scheuermann kyphosis or ankylosing spondylitis. Of the bone removal procedures, it removes the least bone.
The pedicle subtraction osteotomy removes more bone than the PCO described above. A PSO removes the vertebral arch and the pedicles that connect the arch to the vertebral body. Part of the vertebral body is removed as well. This procedure produces about 30 degrees of correction, and can be combined with PCOs in other vertebrae to yield greater overall correction. It is especially useful in treating some cases of ankylosing spondylitis, flatback syndrome, and any sharp, angular kyphosis. A surgeon can also correct some C-shaped scoliosis with a pedicle subtraction osteotomy.
The vertebral column resection (VCR) removes the most bone of all correction and stabilization procedures: it removes the entire vertebra. The vertebra is replaced with bone grafts and implants called cages. A system of screws and rods restore spinal stability while the bone graft heals. This procedure can provide the greatest amount of correction–80 degrees or more. A single vertebra may be removed to correct a sharp curve, or more than one may be removed to correct a broader curve.
Spinopelvic fixation is a procedure in which screws, rods, or other hardware rigidly connect the base of the spine and the surrounding bones of the pelvis. This procedure reduces the forces of bending and rotation at the junction between the lumbar spine and the sacrum. Since these forces are normally great, a spinopelvic fixation can help take the strain off a healing bone fusion in the lower spine.
Balancing the spine is a complex process that must take into account the mechanics of the spine, the spinal cord and nerve roots, and the nearby organs. Achieving the best outcome requires a surgeon to possess technical skill, a thorough familiarity with orthopedic and neurological considerations, and experience tailoring treatment for individual cases.