The effect of posterior spinal releases on axial correction torque: a cadaver study

Posterior only approaches for spinal deformity are increasingly popular and posterior spinal release is utilized to gain flexibility for correctional maneuvers. Prior biomechanical data support the use of facetectomy and rib head resection for gaining flexibility in the sagittal and coronal planes but to date there has been no quantification of stiffness reduction provided by these techniques for axial correction through a pedicle screw construct. We sought to determine the contribution of posterior spinal releases (facetectomy, rib head resection) on axial plane stiffness.

Four fresh-frozen human cadavers were instrumented with fixed angle pedicle screws in the thoracic spine. The torque needed to produce 25° axial deflections at individual spinal segments (levels T5-T11) was measured using a custom needle deflection torque device attached to commercially available vertebral rotating construct. After the intact specimen was tested, torque measurements were repeated following a full facetectomy and posterior rib head resection

Complete facetectomy resulted in an 18% decrease of torque needed to produce 25° of axial deformity compared to the intact specimen (P < 0.001). Rib resection added an additional 36% decrease in torque (P < 0.001).

Complete facetectomies (Ponte or Smith-Petersen osteotomies) decrease the force required to rotate spinal segments with respect to the axial plane by approximately one-fifth. Posterior rib head resection should be considered to further loosen the spine if additional axial correction is desired.