Pedicle Subtraction Osteotomy

What is a Pedicle Subtraction Osteotomy?

A Pedicle Subtraction Osteotomy (PSO) is a form of surgical treatment that is used to reverse spinal deformities.

As the name suggests, osteotomy means “to remove bone.” During a PSO, your doctor will remove (or subtract) a number of bony structures. However, removal of the pedicles (a narrow strip of bone that connects the body of the vertebra to its back side) defines this process.

When it comes to spinal osteotomies, you can think of a PSO as level 2 of deformity correction. Doctors can fix milder cases with a Posterior Column Osteotomy; and more severe cases will require a Vertebral Column Resection.

The idea of removing bone sounds extreme, but here’s why it works:

Your spine isn’t 100% straight. Instead, your lower back contains a gentle sway (known as lordosis) and your upper back curves slightly forward (known as kyphosis). These curves are the exact reverse of one another. But together, they keep your head aligned over your pelvis. When we lose our curvature, it can lead to flatback syndrome. If we gain too much curvature, we can develop kyphosis, or a perpetual slouch.

Although opposite in nature, these problems are known as sagittal imbalance. This simply means that we tip forward (chin on chest syndrome) or backward.

The PSO fixes this by creating a hinge on the back side of the spine… and then closing it. Closing the gap adds lordosis to the lower back, or lumbar spine, and removes kyphosis from the upper back, or thoracic spine.

How is a Pedicle Subtraction Osteotomy Performed?

If you need a PSO, your surgeon will position you face-down, on a slight incline. The incline exposes the back side of your spine, making posterior entrance easy.

Next, your surgeon will attach pedicle screws on either side of the osteotomy site. Then, the true aim of the procedure can begin. Your surgeon will remove or “subtract” your:

Spinous Process: The bony tips that jut out from the back of each vertebrae
Lamina: The bony casing that covers your spinal cord
Facet Joints: The bony hinge where two vertebrae meet
Pedicles: The band of bone that connects the vertebral body to the processes

All of this removal creates an open wedge on the back side of your spine. Adding rods to the pedicle screws, your surgeon will then close this hinge. A bone graft from the patient or a donor supply will be applied to the back side of your spine. This graft replaces the missing bone and works to fuse the gap together. In addition, if you have osteoporosis your doctor may use a special bone graft that contains a specific protein to reinforce your spine.

Do I Qualify for a Pedicle Subtraction Osteotomy?

You may need a PSO if you have:

Flatback Syndrome: If you have flatback syndrome from a failed back surgery
Kyphosis: If you have severe, rigid, or degenerative kyphosis (>75 degrees)
Scoliosis: If you have severe scoliosis (>75 degrees)
Ankylosing Spondylitis (AS): If sections of your spine have fused together from AS
The above situations make an individual ideally suited for a PSO. However, if you are a smoker, have lordosis, or < 75 degrees of curvature, other options make work better for you.

To find out if you qualify for a PSO, contact the Lowenstein team. Dr. Jason Lowenstein uses advanced treatment options and minimally invasive techniques to ensure that you receive the right treatment, at the right time. For spinal deformity relief that you can count on, contact the Lowenstein team today!

What are the Advantages of a Pedicle Subtraction Osteotomy?

A PSO offers many benefits to the patient over older methods. These include:

Posterior-Only Entry: Entering the spine from the back side spares injury to the delicate tissues that support your spine. This means less scarring and speedier recoveries.
Close Monitoring: While the procedure takes place, your doctor will monitor the nerve signals of your spinal cord. This ensures that you do not suffer nerve trauma during the process.
Effective Correction: A PSO offers up to 30 degrees of spinal curvature correction. (In contrast, a PCO only offers 20 degrees or less.)
Fusion & Screws: Using supportive screws and spinal fusion helps your spine to heal faster and maintains long-term stability.

Need a PSO to fix your neck or back pain? You deserve only the best! Dr. Lowenstein is a fellowship-trained, top-rated surgeon in New Jersey, who specializes in complex bone removal procedures!