What is a spinal osteotomy?
A spinal osteotomy is a procedure in which controlled cuts are made through the vertebral bone to allow the spine to be realigned into a corrected position. Osteotomies are required when spinal deformity is rigid — meaning the spine will not correct with positioning or instrumentation alone — and when the degree of correction required exceeds what can be achieved through standard posterior instrumentation.
Three types of osteotomy are commonly performed based on the degree of correction required. The Smith-Petersen osteotomy removes the posterior elements only and achieves correction through the disc space — used for flexible deformity requiring moderate correction. The pedicle subtraction osteotomy removes the posterior elements and a wedge of the vertebral body — achieving 30 to 40 degrees of correction in a single level. The vertebral column resection removes the entire vertebra and adjacent discs — the most powerful osteotomy, used for the most severe deformities.
Dr. Enguidanos performs all three osteotomy types. His fellowship training at the University of Colorado Spine Center under Dr. Thomas Lowe — the former president of the Scoliosis Research Society — specifically included complex osteotomy technique. He serves patients from across the Florida Panhandle and Gulf Coast at HCA Florida Twin Cities Hospital in Niceville, Florida who have been told their deformity cannot be corrected.
The procedure.
Posterior Exposure and Instrumentation
The spine is exposed posteriorly and pedicle screws are placed above and below the planned osteotomy level. The instrumentation will be used to apply the corrective force once the osteotomy is complete.
Osteotomy Execution
The type of osteotomy — SPO, PSO, or VCR — determines the bone to be removed. For a pedicle subtraction osteotomy, the spinous process, lamina, facets, pedicles, and a posterior wedge of the vertebral body are removed on both sides.
Controlled Closure
Once the bone is removed, the spine is carefully closed through the osteotomy — either by controlled positioning or by applying compression through the instrumentation. The spinal cord is monitored continuously during this maneuver.
Deformity Correction Achieved
The correction is assessed both clinically and fluoroscopically. Rod contouring and final tightening of all instrumentation holds the corrected position while fusion occurs.
Bone Graft and Closure
Bone graft is applied throughout the fusion construct. The wound is closed over drains. Neurological monitoring is maintained until the patient is awake and confirms intact neurological function.