The Intradiscal Osteotomy: An Alternative Technique for Adult Spinal Deformity Correction.

Wyatt L Ramey,Jens Chapman,Andrew S Jack,Robert A Hart,Rod J Oskouian

doi:10.7759/cureus.19062

Abstract

Adult spinal deformity (ASD) correction has changed considerably since the initial description of a Smith-Petersen osteotomy (SPO), including pedicle subtraction osteotomies (PSO), and more minimally invasive techniques. Here, we introduce and describe the intradiscal osteotomy (IDO), a novel variation of Schwab type 3 and 4 osteotomies allowing pedicle and vertebral body preservation, and its advantages and disadvantages.After pedicle screw placement, the posterior elements (except pedicles) are removed from the appropriate vertebrae, including the superior/inferior articulating processes, laminae, and spinous processes. An osteotome is used to remove the posterior aspect of the superior and inferior endplate, followed by the entire disc, creating more working room for eventual cage insertion. After the careful release of the annulus, an intradiscal distractor is used to distract the endplates and allow interbody cage insertion as anteriorly as possible. Pedicle and vertebral body preservation allow increased fixation and endplate cage support, which lengthens the anterior column and acts as a fulcrum when compressing posteriorly to restore lordosis. By allowing for anterior and posterior column release, the IDO technique provides a feasible, all-posterior approach for the correction of fixed or flexible kyphoscoliotic curves.This technical report introduces and describes the IDO as an alternative method for thoracic and/or lumbar ASD correction. More studies are required to fully elucidate its outcome vs. complication profile compared to other deformity correction techniques.

Highlights

The advent of modern spinal deformity surgery has been revolutionized by the development of spinopelvic parameters and the recognition of the importance of sagittal alignment [1]
We aim to introduce and provide the first description of the intradiscal osteotomy, a variation of the Schwab grade 3 and 4 osteotomies, as an alternative means of restoring spinopelvic parameters and achieving adequate Adult spinal deformity (ASD) correction
The intradiscal osteotomy (IDO) is similar to a transforaminal lumbar interbody fusion (TLIF) in that the facet is obliterated in order to place an interbody cage; the bony work within the confines of the posterior disc space is more extensive and deliberate in order to achieve sagittal correction when compressing posteriorly, which is not always performed with a standard TLIF

Summary

Introduction

The advent of modern spinal deformity surgery has been revolutionized by the development of spinopelvic parameters and the recognition of the importance of sagittal alignment [1]. The removal of the posterior aspect of the endplates allows for increased working room for interbody device/cage and bone graft placement into the disc space, as well as facilitates compression posteriorly after cage placement to help restore sagittal balance (see below). The IDO is similar to a transforaminal lumbar interbody fusion (TLIF) in that the facet is obliterated in order to place an interbody cage; the bony work within the confines of the posterior disc space is more extensive and deliberate in order to achieve sagittal correction when compressing posteriorly, which is not always performed with a standard TLIF. The IDO prevents the posterior aspects of the vertebral bodies from “binding” against one another, which would move the axis of rotation during the sagittal correction to the posterior disc space and potentially result in the anterior interbody cage loosening by distracting the anterior column. In the event of a coronal plane deformity, an interbody cage may be placed asymmetrically with contralateral compression to facilitate the correction

Discussion

Conclusions

Disclosures