Mini-open pedicle subtraction osteotomy: surgical technique

Minimally invasive spinal surgery (MISS) has many favorable attributes that would be of great benefit to patients with an adult spinal deformity. Decreased blood loss, lower infection rates, and faster mobilization may help to reduce the high rate of complications associated with these interventions. Although correction of coronal deformity has been well demonstrated with MISS, improvements in lordosis and sagittal balance have remained relatively elusive using the MISS approach. With open surgery, the most powerful techniques for improving sagittal balance include some form of a spinal osteotomy.

In this report, we describe the evolution of a technique for treating thoracolumbar kyphoscoliosis using a mini-open pedicle subtraction osteotomy (PSO) combined with interbody fusion and percutaneous pedicle screws.

The patient underwent a T10 to S1 percutaneous posterior instrumented with an L3 PSO and right L4/5 minimally invasive transforaminal interbody fusion. Clinically, the patient had excellent improvement and regained the ability to ambulate independently for distances of up to one half mile. Imaging demonstrated good correction of coronal imbalance (1.8 to 9.5 cm) and sagittal imbalance (sagittal vertical axis of 22.5 to 7 cm).

The correction of sagittal plane deformities remains difficult using MISS approaches. In this report, we describe a new technique using a mini-open PSO technique to achieve significant improvement in thoracolumbar lordosis.