Louer Craig R, Illingworth Kenneth D, Metcalf Tyler D, Floccari Lorena V
Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
J Pediatr Soc North Am. 2024 Feb 12;5(1):638. doi: 10.55275/JPOSNA-2023-638. eCollection 2023 Feb.
The posterior column osteotomy (PCO) is an adjunct technique for obtaining deformity correction during posterior spine fusion procedures. Full disarticulation of the posterior spinal column, including bony elements (namely the lamina and facet joints) and ligamentous complex is described as a PCO. This technique was originally described to allow for shortening of the posterior column during correction of excessive thoracic kyphosis; however, its indications have since been expanded to other spine deformities such as adolescent idiopathic scoliosis (AIS). Its expanded role in deformity surgery has been met with controversy: proponents tout increased flexibility and better spinal correction in three planes, while detractors cite lack of ostensible clinical benefit and potential for more complications. Differences in surgical technique are also prevalent. In this manuscript, we review the surgical technique of PCOs, including the traditional PCO as well as a modified posterior column release (PCR). Additionally, the controversy over when this technique should be utilized is further explored through summation of current literature on PCO outcomes. •The indications for posterior column osteotomies in pediatric spine deformity surgery are frequently debated, with the risk-benefit profile weighed differently among surgeons.•Proponents of PCO use in scoliosis assert improved flexibility and correction of spinal deformity in three dimensions, in particular the ability to better restore thoracic kyphosis.•Most studies acknowledge that there is an increased risk of a neuromonitoring alert when PCOs are performed, though a significant difference in postoperative deficits has not been described.•The traditional Posterior Column Osteotomy PCO (i.e., "Ponte" osteotomy) is performed by creating a gap in the posterior elements which can be closed down with deformity correction (namely kyphosis).•The modified Posterior Column Osteotomy (or Posterior Column Release [PCR]) can be performed by disarticulating the posterior tension band but leaving a smaller gap, perhaps limiting the ability for posterior compression but limiting spinal canal exposure.
后路截骨术（PCO）是一种在脊柱后路融合手术中用于获得畸形矫正的辅助技术。后路脊柱全关节离断术，包括骨结构（即椎板和小关节）和韧带复合体，被描述为PCO。该技术最初被描述用于在矫正过度的胸椎后凸时缩短后柱；然而，其适应证后来已扩展到其他脊柱畸形，如青少年特发性脊柱侧凸（AIS）。其在畸形手术中不断扩大的作用引发了争议：支持者称赞其增加了灵活性并能在三个平面上更好地矫正脊柱，而反对者则指出缺乏明显的临床益处以及更多并发症的可能性。手术技术的差异也很普遍。在本手稿中，我们回顾了PCO的手术技术，包括传统的PCO以及改良的后路松解术（PCR）。此外，通过总结当前关于PCO结果的文献，进一步探讨了何时应使用该技术的争议。
•小儿脊柱畸形手术中后路截骨术的适应证经常受到争议，不同外科医生对风险效益的权衡有所不同。
•PCO用于脊柱侧凸的支持者声称，其提高了灵活性并能在三维空间矫正脊柱畸形，特别是能更好地恢复胸椎后凸。
•大多数研究承认，进行PCO时神经监测警报的风险增加，尽管术后神经功能缺损的显著差异尚未见报道。
•传统的后路截骨术（即“Ponte”截骨术）是通过在后结构中制造一个间隙来进行的，该间隙可通过畸形矫正（即后凸）来闭合。
•改良的后路截骨术（或后路松解术[PCR]）可通过离断后张力带但留下较小间隙来进行，这可能会限制后柱压缩能力，但可减少椎管暴露。
