Clinical Outcomes of V-Shaped Lamina Osteotomy in Correction of Spinal Deformities: A Technical Report
A case report
,
Abstract
Background: Multiple osteotomy techniques have been developed to manage spinal deformities by alleviating symptoms, restoring spinal alignment, and halting progression. Techniques such as Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO), and vertebral column resection (VCR) vary in invasiveness and efficacy. Greater correction generally requires more extensive bone and soft tissue resection, which increases surgical complexity and the risk of complications. The V-shaped lamina osteotomy is a modified grade 1 posterior column osteotomy (PCO) designed to address multilevel deformities with reduced morbidity. This study evaluates its clinical safety and effectiveness.
Methods: In this retrospective analysis, 28 patients underwent multilevel V-shaped lamina osteotomy from 2005 to 2015. Diagnoses included idiopathic scoliosis (n = 7), degenerative scoliosis (n = 7), Scheuermann’s kyphosis (n = 4), and iatrogenic deformity (n = 10). Patients under 10 or over 80 years of age and those with traumatic, infectious, or malignant deformities were excluded.
Results: No intraoperative deaths, neurologic injuries, or major complications occurred. Two patients experienced superficial wound infections, which were resolved with debridement and antibiotics. All patients demonstrated significant sagittal and coronal alignment improvement. Mean blood loss was higher in patients undergoing four (or more)-segment osteotomies (350-500 ml) compared to those with two or three segments (200-300 ml). Surgical time ranged from approximately 4 hours for fewer segments to up to 6 hours for extensive procedures.
Conclusion: V-shaped lamina osteotomy is a safe, efficient technique for correcting multilevel spinal deformities. It offers comparable results to more invasive procedures while minimizing complications, making it suitable for long, smooth deformities.
1. Steinmetz MP, Benzel EC. Benzel's Spine Surgery E-Book: Techniques, Complication Avoidance, and Management. 4th ed. Philadelphia, PA: Elsevier; 2016.
2. Bridwell KH, Gupta M. Bridwell and DeWald's textbook of spinal surgery. 4th ed. Philadelphia, PA: Wolters Kluwer Health; 2019.
3. Canale ST, Beaty JH. Campbell's Operative Orthopaedics, E- Book. Philadelphia, PA: Elsevier Health Sciences; 2020.
4. Bess S, Schwab F, Lafage V, Shaffrey CI, Ames CP. Classifications for adult spinal deformity and use of the Scoliosis Research Society-Schwab Adult Spinal Deformity Classification. Neurosurg Clin N Am. 2013;24(2):185-93. doi: 10.1016/j.nec.2012.12.008. [PubMed: 23561557].
5. Savage JW, Patel AA. Fixed sagittal plane imbalance. Glob Spine J. 2014;4(4):287-95. doi: 10.1055/s-0034-1394126. [PubMed: 25396111]. [PubMed Central: PMC4229376].
6. Garfin SR, Eismont FJ, Bell GR, Bono CM, Fischgrund JS. Rothman-Simeone the spine e-book. 7th ed. Philadelphia, PA:Elsevier; 2017.
7. Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976). 2012;37(12):1077-82. doi: 10.1097/BRS.0b013e31823e15e2. [PubMed: 22045006].
8. Gupta MC, Kebaish K, Blondel B, Klineberg E. Spinal osteotomies for rigid deformities. Neurosurg Clin N Am. 2013;24(2):203-11. doi: 10.1016/j.nec.2012.12.001. [PubMed: 23561559].
9. Wang Y, Boachie-Adjei O, Lenke L. Spinal Osteotomy. Berlin, Germany: Springer; 2014.
10. Winn HR. Youmans and Winn Neurological Surgery: 4-Volume Set. Philadelphia, PA: Elsevier; 2022.
11. Patel RV, Yearley AG, Isaac H, Chalif EJ, Chalif JI, Zaidi HA. Advances and Evolving Challenges in Spinal Deformity Surgery. J Clin Med. 2023;12(19):6386. doi: 10.3390/jcm12196386. [PubMed: 37835030]. [PubMed Central: PMC10573859].
12. Gokcen B, Yilgor C, Alanay A. Osteotomies/spinal column resection in paediatric deformity. Eur J Orthop Surg Traumatol. 2014;24(Suppl 1):S59-68. doi: 10.1007/s00590-014- 1477-1. [PubMed: 24845458].
13. Everett CR, Patel RK. A systematic literature review of nonsurgical treatment in adult scoliosis. Spine (Phila Pa 1976). 2007;32(19 Suppl):S130-4. doi: 10.1097/BRS.0b013e318134ea88. [PubMed: 17728680].
14. Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus. 2010;28(3):E1. doi: 10.3171/2010.1.Focus09271. [PubMed: 20192655].
15. Diab MG, Franzone JM, Vitale MG. The role of posterior spinal osteotomies in pediatric spinal deformity surgery: indications and operative technique. J Pediatr Orthop. 2011;31(1 Suppl):S88-98. doi: 10.1097/BPO.0b013e3181f73bd4. [PubMed: 21173625].
16. Hu WH, Wang Y. Osteotomy Techniques for Spinal Deformity. Chin Med J (Engl). 2016;129(21):2639-41. doi: 10.4103/0366-6999.192774. [PubMed: 27779173]. [PubMed Central: PMC5125345].
17. Obeid I, Boissière L, Vital JM, Bourghli A. Osteotomy of the spine for multifocal deformities. Eur Spine J. 2015;24(Suppl 1):S83-92. doi: 10.1007/s00586-014-3660-9. [PubMed: 25391623].
18. Smith-Petersen M, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg. 1945;27(1):1-11.
19. Enercan M, Ozturk C, Kahraman S, Sarıer M, Hamzaoglu A, Alanay A. Osteotomies/spinal column resections in adult deformity. Eur Spine J. 2013;22 Suppl 2(Suppl 2):S254-64. doi: 10.1007/s00586-012-2313-0. [PubMed: 22576156]. [PubMed Central: PMC3616463].
20. Diebo B, Liu S, Lafage V, Schwab F. Osteotomies in the treatment of spinal deformities: indications, classification, and surgical planning. Eur J Orthop Surg Traumatol. 2014;24(Suppl 1):S11-20. doi: 10.1007/s00590-014-1471-7. [PubMed: 24816823].
21. Dorward IG, Lenke LG. Osteotomies in the posterior-only treatment of complex adult spinal deformity: a comparative review. Neurosurg Focus. 2010;28(3):E4. doi: 10.3171/2009.12.Focus09259. [PubMed: 20192665].
22. Voos K, Boachie-Adjei O, Rawlins BA. Multiple vertebral osteotomies in the treatment of rigid adult spine deformities. Spine (Phila Pa 1976). 2001;26(5):526-33. doi: 10.1097/00007632- 200103010-00016. [PubMed: 11242380].
23. Gill JB, Levin A, Burd T, Longley M. Corrective osteotomies in spine surgery. J Bone Joint Surg Am. 2008;90(11):2509-20. doi: 10.2106/jbjs.H.00081. [PubMed: 18978421].
24. Ramieri A, Miscusi M, Domenicucci M, Raco A, Costanzo G. Surgical management of coronal and sagittal imbalance of the spine without PSO: a multicentric cohort study on compensated adult degenerative deformities. Eur Spine J. 2017;26(Suppl 4):442-9. doi: 10.1007/s00586-017-5042-6. [PubMed: 28303383].
25. Ghobrial GM, Lebwohl NH, Green BA, Gjolaj JP. Multilevel Schwab grade II osteotomies for sagittal plane correction in the management of adult spinal deformity. Spine J. 2017;17(11):1594-600. doi: 10.1016/j.spinee.2017.05.013. [PubMed: 28502881].
26. Han S, Hyun SJ, Kim KJ, Jahng TA, Kim HJ, Lee BH, et al. Multilevel Posterior Column Osteotomies Are Not Inferior For the Correction of Rigid Adult Spinal Deformity Compared with Pedicle Subtraction Osteotomy. World Neurosurg. 2017;107:839-45. doi: 10.1016/j.wneu.2017.08.116. [PubMed: 28847551].
27. Long Z, Gong F, Xiong L, Wen J, Chen G. Modified posterior osteotomy for osteoporotic vertebral collapse with neurological dysfunction in thoracolumbar spine: a preliminary study. J Orthop Surg Res. 2023;18(1):688. doi: 10.1186/s13018-023-04189-3. [PubMed: 37715231]. [PubMed Central: PMC10502986].
28. Liu FY, Gu ZF, Zhao ZQ, Ren L, Wang LM, Yu JH, et al. Modified grade 4 osteotomy for the correction of post-traumatic thoracolumbar kyphosis: A retrospective study of 42 patients. Medicine (Baltimore). 2020;99(37):e22204. doi: 10.1097/md.0000000000022204. [PubMed: 32925797]. [PubMed Central: PMC7489674].
29. Liu FY, Zhao ZQ, Ren L, Gu ZF, Li F, Ding WY, et al. Modified grade 4 osteotomy for kyphosis due to old osteoporotic vertebral compression fractures: Two case reports. Medicine (Baltimore). 2018;97(52):e13846. doi: 10.1097/md.0000000000013846. [PubMed: 30593184]. [PubMed Central: PMC6314658].
30. Fakurnejad S, Scheer JK, Lafage V, Smith JS, Deviren V, Hostin R, et al. The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy: analysis of 140 patients. J Neurosurg Spine. 2015;23(3):340-8. doi: 10.3171/2014.12.Spine141031. [PubMed: 26091440].
31. Scheer JK, Lafage V, Smith JS, Deviren V, Hostin R, McCarthy IM, et al. Impact of age on the likelihood of reaching a minimum clinically important difference in 374 three-column spinal osteotomies: clinical article. J Neurosurg Spine. 2014;20(3): 306-12. doi: 10.3171/2013.12.Spine13680. [PubMed: 24405466].
32. Mills ES, Mertz K, Faye E, Bell JA, Ton AT, Wang JC, et al. Complication Rates and Utilization Trends of 3-Level Posterior Column Osteotomy Compared to Single-Level Pedicle Subtraction Osteotomy. Neurospine. 2023;20(2):662-8. doi: 10.14245/ns.2346222.111. [PubMed: 37401085]. [PubMed Central: PMC10323336].
33. Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 2015;76(Suppl 1):S33-41; discussion S. doi: 10.1227/01.neu.0000462076.73701.09. [PubMed: 25692366].
34. Ha AS, Cerpa M, Lenke LG. State of the art review: Vertebral Osteotomies for the management of Spinal Deformity. Spine Deform. 2020;8(5):829-43. doi: 10.1007/s43390-020-00144-y. [PubMed: 32468384].
2. Bridwell KH, Gupta M. Bridwell and DeWald's textbook of spinal surgery. 4th ed. Philadelphia, PA: Wolters Kluwer Health; 2019.
3. Canale ST, Beaty JH. Campbell's Operative Orthopaedics, E- Book. Philadelphia, PA: Elsevier Health Sciences; 2020.
4. Bess S, Schwab F, Lafage V, Shaffrey CI, Ames CP. Classifications for adult spinal deformity and use of the Scoliosis Research Society-Schwab Adult Spinal Deformity Classification. Neurosurg Clin N Am. 2013;24(2):185-93. doi: 10.1016/j.nec.2012.12.008. [PubMed: 23561557].
5. Savage JW, Patel AA. Fixed sagittal plane imbalance. Glob Spine J. 2014;4(4):287-95. doi: 10.1055/s-0034-1394126. [PubMed: 25396111]. [PubMed Central: PMC4229376].
6. Garfin SR, Eismont FJ, Bell GR, Bono CM, Fischgrund JS. Rothman-Simeone the spine e-book. 7th ed. Philadelphia, PA:Elsevier; 2017.
7. Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976). 2012;37(12):1077-82. doi: 10.1097/BRS.0b013e31823e15e2. [PubMed: 22045006].
8. Gupta MC, Kebaish K, Blondel B, Klineberg E. Spinal osteotomies for rigid deformities. Neurosurg Clin N Am. 2013;24(2):203-11. doi: 10.1016/j.nec.2012.12.001. [PubMed: 23561559].
9. Wang Y, Boachie-Adjei O, Lenke L. Spinal Osteotomy. Berlin, Germany: Springer; 2014.
10. Winn HR. Youmans and Winn Neurological Surgery: 4-Volume Set. Philadelphia, PA: Elsevier; 2022.
11. Patel RV, Yearley AG, Isaac H, Chalif EJ, Chalif JI, Zaidi HA. Advances and Evolving Challenges in Spinal Deformity Surgery. J Clin Med. 2023;12(19):6386. doi: 10.3390/jcm12196386. [PubMed: 37835030]. [PubMed Central: PMC10573859].
12. Gokcen B, Yilgor C, Alanay A. Osteotomies/spinal column resection in paediatric deformity. Eur J Orthop Surg Traumatol. 2014;24(Suppl 1):S59-68. doi: 10.1007/s00590-014- 1477-1. [PubMed: 24845458].
13. Everett CR, Patel RK. A systematic literature review of nonsurgical treatment in adult scoliosis. Spine (Phila Pa 1976). 2007;32(19 Suppl):S130-4. doi: 10.1097/BRS.0b013e318134ea88. [PubMed: 17728680].
14. Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus. 2010;28(3):E1. doi: 10.3171/2010.1.Focus09271. [PubMed: 20192655].
15. Diab MG, Franzone JM, Vitale MG. The role of posterior spinal osteotomies in pediatric spinal deformity surgery: indications and operative technique. J Pediatr Orthop. 2011;31(1 Suppl):S88-98. doi: 10.1097/BPO.0b013e3181f73bd4. [PubMed: 21173625].
16. Hu WH, Wang Y. Osteotomy Techniques for Spinal Deformity. Chin Med J (Engl). 2016;129(21):2639-41. doi: 10.4103/0366-6999.192774. [PubMed: 27779173]. [PubMed Central: PMC5125345].
17. Obeid I, Boissière L, Vital JM, Bourghli A. Osteotomy of the spine for multifocal deformities. Eur Spine J. 2015;24(Suppl 1):S83-92. doi: 10.1007/s00586-014-3660-9. [PubMed: 25391623].
18. Smith-Petersen M, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg. 1945;27(1):1-11.
19. Enercan M, Ozturk C, Kahraman S, Sarıer M, Hamzaoglu A, Alanay A. Osteotomies/spinal column resections in adult deformity. Eur Spine J. 2013;22 Suppl 2(Suppl 2):S254-64. doi: 10.1007/s00586-012-2313-0. [PubMed: 22576156]. [PubMed Central: PMC3616463].
20. Diebo B, Liu S, Lafage V, Schwab F. Osteotomies in the treatment of spinal deformities: indications, classification, and surgical planning. Eur J Orthop Surg Traumatol. 2014;24(Suppl 1):S11-20. doi: 10.1007/s00590-014-1471-7. [PubMed: 24816823].
21. Dorward IG, Lenke LG. Osteotomies in the posterior-only treatment of complex adult spinal deformity: a comparative review. Neurosurg Focus. 2010;28(3):E4. doi: 10.3171/2009.12.Focus09259. [PubMed: 20192665].
22. Voos K, Boachie-Adjei O, Rawlins BA. Multiple vertebral osteotomies in the treatment of rigid adult spine deformities. Spine (Phila Pa 1976). 2001;26(5):526-33. doi: 10.1097/00007632- 200103010-00016. [PubMed: 11242380].
23. Gill JB, Levin A, Burd T, Longley M. Corrective osteotomies in spine surgery. J Bone Joint Surg Am. 2008;90(11):2509-20. doi: 10.2106/jbjs.H.00081. [PubMed: 18978421].
24. Ramieri A, Miscusi M, Domenicucci M, Raco A, Costanzo G. Surgical management of coronal and sagittal imbalance of the spine without PSO: a multicentric cohort study on compensated adult degenerative deformities. Eur Spine J. 2017;26(Suppl 4):442-9. doi: 10.1007/s00586-017-5042-6. [PubMed: 28303383].
25. Ghobrial GM, Lebwohl NH, Green BA, Gjolaj JP. Multilevel Schwab grade II osteotomies for sagittal plane correction in the management of adult spinal deformity. Spine J. 2017;17(11):1594-600. doi: 10.1016/j.spinee.2017.05.013. [PubMed: 28502881].
26. Han S, Hyun SJ, Kim KJ, Jahng TA, Kim HJ, Lee BH, et al. Multilevel Posterior Column Osteotomies Are Not Inferior For the Correction of Rigid Adult Spinal Deformity Compared with Pedicle Subtraction Osteotomy. World Neurosurg. 2017;107:839-45. doi: 10.1016/j.wneu.2017.08.116. [PubMed: 28847551].
27. Long Z, Gong F, Xiong L, Wen J, Chen G. Modified posterior osteotomy for osteoporotic vertebral collapse with neurological dysfunction in thoracolumbar spine: a preliminary study. J Orthop Surg Res. 2023;18(1):688. doi: 10.1186/s13018-023-04189-3. [PubMed: 37715231]. [PubMed Central: PMC10502986].
28. Liu FY, Gu ZF, Zhao ZQ, Ren L, Wang LM, Yu JH, et al. Modified grade 4 osteotomy for the correction of post-traumatic thoracolumbar kyphosis: A retrospective study of 42 patients. Medicine (Baltimore). 2020;99(37):e22204. doi: 10.1097/md.0000000000022204. [PubMed: 32925797]. [PubMed Central: PMC7489674].
29. Liu FY, Zhao ZQ, Ren L, Gu ZF, Li F, Ding WY, et al. Modified grade 4 osteotomy for kyphosis due to old osteoporotic vertebral compression fractures: Two case reports. Medicine (Baltimore). 2018;97(52):e13846. doi: 10.1097/md.0000000000013846. [PubMed: 30593184]. [PubMed Central: PMC6314658].
30. Fakurnejad S, Scheer JK, Lafage V, Smith JS, Deviren V, Hostin R, et al. The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy: analysis of 140 patients. J Neurosurg Spine. 2015;23(3):340-8. doi: 10.3171/2014.12.Spine141031. [PubMed: 26091440].
31. Scheer JK, Lafage V, Smith JS, Deviren V, Hostin R, McCarthy IM, et al. Impact of age on the likelihood of reaching a minimum clinically important difference in 374 three-column spinal osteotomies: clinical article. J Neurosurg Spine. 2014;20(3): 306-12. doi: 10.3171/2013.12.Spine13680. [PubMed: 24405466].
32. Mills ES, Mertz K, Faye E, Bell JA, Ton AT, Wang JC, et al. Complication Rates and Utilization Trends of 3-Level Posterior Column Osteotomy Compared to Single-Level Pedicle Subtraction Osteotomy. Neurospine. 2023;20(2):662-8. doi: 10.14245/ns.2346222.111. [PubMed: 37401085]. [PubMed Central: PMC10323336].
33. Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 2015;76(Suppl 1):S33-41; discussion S. doi: 10.1227/01.neu.0000462076.73701.09. [PubMed: 25692366].
34. Ha AS, Cerpa M, Lenke LG. State of the art review: Vertebral Osteotomies for the management of Spinal Deformity. Spine Deform. 2020;8(5):829-43. doi: 10.1007/s43390-020-00144-y. [PubMed: 32468384].
| Files | ||
| Issue | Vol 11 No 3 (2025) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v11i3.19404 | |
| Keywords | ||
| Osteotomy Deformities Kyphosis Scoliosis | ||
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How to Cite
1.
Shabani S, Malekzadeh M, Mirzashahi B. Clinical Outcomes of V-Shaped Lamina Osteotomy in Correction of Spinal Deformities: A Technical Report. J Orthop Spine Trauma. 2025;11(3):100-4.
