European Spine Journal (2017) 26 (Suppl 5):S560–S561
OPEN OPERATING THEATRE (OOT)
Posterior only approach to open wedge osteotomy
in the thoracolumbar spine
· Melanie Liem
· Johannes Holz
· Alf Giese
© Springer-Verlag GmbH Germany, part of Springer Nature 2017
Keywords Open wedge osteotomy · Open spinal spondylodesis · Sagittal balance · Kyphosis · Posterior spinal fusion ·
Anterior spinal release · Intercorporal fusion · Thoracolumbar kyphotic deformity · Bone disc bone osteotomy
How to perform an open spondylodesis with decompression
anterior retropleural release intercorporal fusion and bone
disc bone and open wedge osteotomy as a posterior only
Over the last decades, spinal procedures have greatly
improved, providing increased safety and eﬀectiveness with
decreased complication rate and improved functional out-
come. The relevance of a sagittal balanced spine especially
in the thoracolumbar area has been described several times.
Rigid kyphotic deformities in that area require a restoration
of the sagittal proﬁle also to relieve the myelon cord. To
achieve a balanced spine, diﬀerent types of procedures are
described including combined anterior–posterior deformity
corrections. An anterior release has been described as a sub-
stantial part in anterior fused and rigid kyphotic deformity
Here we present a surgical technique of an open approach
of posterior only deformity correction with open wedge oste-
otomy, intercorporal fusion as well as anterior release with
retropleural resection of the anterior ligament.
The patient is a 54-year-old female with a history of pro-
gressive rigid kyphotic deformity over 3 years at the level
of Th12/L1 with a sclerotic defect and stenosis with con-
secutive myelon cord compression at Th12-L1. Paraspas-
ticity was present as a consequence of perinatal hypoxia.
Patient was presented with severe low back pain but without
Further diagnostic with X-ray, MRI and CT scan showed
a fused and sclerotic segment of Th12 and L1 and osteo-
chondrosis Modic type 3 with progressive kyphotic deform-
ity of 23° and spinal canal stenosisTh12/L1.
Prior to deformity correction a biopsy of L1 was done
to exclude tumor or inﬂammatory and infectious disease.
Because of the paraspasticity we performed a short seg-
ment spondylodesis with bone-disc-bone osteotomy without
replacement of L1 vertebral body.
The patient’s condition, diagnosis, prognosis, the ben-
eﬁts and risks of the surgical intervention were thoroughly
discussed and the patient agreed and signed an informed
The patient was anaesthetized, intubated and placed in
prone position. After skin disinfection and sterile draping
a team time-out was performed. Median skin incision was
Electronic supplementary material The online version of this
article (https://doi.org/10.1007/s00586-017-5382-2) contains
supplementary material, which is available to authorized users.
* Nils Hansen-Algenstaedt
Department of Spine Surgery, OrthoCentrum Hamburg,
Park-Klinik Manhagen, Hansastrasse 1-3, 20149 Hamburg,
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