Mehmet TEZER, Önder AYDINGÖZ, Fatih DİKİCİ, Ünsal DOMANİÇ, Emin ALICI
Journal of Turkish Spinal Surgery - 2026;37(EK-1):36-43
Spinal deformity is a condition that can arise at any age, from early childhood to advanced age, and may result from a wide range of causes (congenital, neuromuscular, etc.). Spinal deformities can affect the entire spine, causing dysfunction at a young age; however, when they occur later in life, they can lead to progressive asymmetric degeneration, resulting in clinical problems ranging from axial back pain to neurological deficits. Advances in implant technology and surgical techniques have enabled more effective treatment of spinal deformities. While spinal alignment can be achieved with standard methods in flexible deformities, vertebral osteotomies are required to obtain the correction necessary for clinical improvement in rigid cases. Generally, osteotomies can be categorized into three main types: posterior column osteotomies (PCO), including Smith-Petersen osteotomy (SPO) and Ponte osteotomy; pedicle subtraction osteotomies (PSO); and vertebral column resections (VCR)/posterior VCR (PVCR). A single-level PCO achieves 10-20 degrees of correction for kyphotic deformities. When surgical experience is insufficient to permit more extensive osteotomies, PCOs (SPO and Ponte) are considered the least complex procedures available. PSO is a three-column osteotomy in which the pedicles and portions of the vertebral body are resected to form a wedge. With maximal bone resection, PSO typically provides approximately 30 degrees of correction at the lumbar level. Bone-disc-bone osteotomy can be considered an extended osteotomy within this group, in which bone sections are removed from both the upper and lower regions at the disc level. Generally, this technique corrects deformities between 35 derece and 60 derece. Domanic osteotomy, a type of total wedge osteotomy, involves the resection of the posterior and middle columns, terminating at the anterior cortex while preserving the anterior longitudinal ligament. With Domanic osteotomy, a maximum correction of 65 degrees can be achieved in a single procedure. VCR/PVCR involves the aggressive removal of one or more vertebral bodies. These osteotomies are the most powerful posterior osteotomy methods, enabling successful correction of severe and complex deformities. Because these surgeries are technically demanding and carry a high risk of complications, it is recommended that they be performed only by experienced teams.
