Posterior Column Osteotomy
What is a Posterior Column Osteotomy?
A Posterior Column Osteotomy (PCO) is a form of surgical correction that is used to fix spinal deformities. You may also hear a PCO referred to as a Smith-Petersen Osteotomy or a Ponte Osteotomy.
In general, spinal osteotomies are a class of deformity correction that involves removing bone. Hence, the osteo- part, which stands for “bone” and the -otomy part, which means “to cut.”
Doctors treat mild cases of scoliosis, kyphosis, or flatback syndrome that require surgery with a PCO. Other types of osteotomies include the Pedicle Subtraction Osteotomy for more moderate cases; and the Vertebral Column Resection for severe cases.
Keep in mind that your spine contains a set of natural curves. The swaying of the lower back (lordosis) and the forward curve of the upper spine (kyphosis) act to create balance and symmetry. Loss of either of these curves can lead to flatback syndrome. Similarly, too much curvature can cause imbalance.
A sagittal imbalance occurs when the curves of our upper and lower back are no longer equal. You’ve probably heard of kyphosis. This form of sagittal imbalance occurs when your thoracic spine develops a forward hump.
In addition, your surgeon may use a PCO to correct pediatric or adult scoliosis or ankylosing spondylitis.
How is a Posterior Column Osteotomy Performed?
Specifically, the “posterior” part of a PCO means that your surgeon will access your spine from the back side.
After making a small incision, your surgeon will insert pedicle screws into your vertebrae. These screws are mounted to the posterior spinal column, above and below the osteotomy site.
Then, the bone removal process can begin. Your surgeon will remove and/or trim your:
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- Spinous Process: The bony “point” on the back-side of each vertebrae
- Lamina: The sheath that houses your spinal cord
- Facet Joints: The bony joint where two vertebrae connect to create movement
- Ligamentum Flavum: The stretchy tissue that connects one vertebra to another
After “loosening” your spine, your doctor will adjust your vertebrae into the correct positions. This key process often requires the use of implants to maintain proper alignment.
With the spine in its ideal position, your doctor will attach rods to the screws to hold your spine in place. Sometimes, a bone graft from the patient is used to reinforce the posterior vertebral column. As the graft matures, the back side of your spine will fuse together. Because only a few vertebrae undergo the fusion process, you will maintain mobility in your back.
Lastly, your doctor will close the incision and you will receive after-care instructions.
One PCO can give up to 20 degrees of improvement in curvature. For worse curves, more than one PCO may be needed.
Do I Qualify for a Posterior Column Osteotomy?
You may need a PCO if you have scoliosis, Scheuermann’s kyphosis, or flatback syndrome.
However, if you have scoliosis or kyphosis, your curve must be severe (45 degrees or higher). If this does not apply to you, then non-surgical options, like scoliosis bracing, may work best.
Unfortunately, a PCO will not be able to help everybody. When we remove bone, our spinal discs must be strong enough to support the spine in its absence. If you have weak discs, you may need a spinal fusion instead.
To find out if you qualify for PCO, contact Dr. Lowenstein. An expert at PCO, Dr. Lowenstein will get you on the path to recovery!