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Related Concept Videos

Articulations of the Vertebral Column01:28

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The vertebral column or spine is a flexible column that supports the head, neck, and body and  allows for their movements. It also protects the spinal cord.
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Related Experiment Video

Updated: Apr 29, 2026

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Complex osteotomies vertebral column resection and decancellation.

Ibrahim Obeid1, Anouar Bourghli, Louis Boissière

  • 1Department of Orthopaedics and Spine Surgery, University Hospital of Bordeaux, Bordeaux, France, ibrahim.obeid@gmail.com.

European Journal of Orthopaedic Surgery & Traumatology : Orthopedie Traumatologie
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Summary

Complex spinal malalignments, including coronal and mixed imbalances, require advanced surgical techniques beyond standard pedicle subtraction osteotomy (PSO). This review covers specialized procedures and navigation

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Area of Science:

  • Spine surgery
  • Orthopedics
  • Surgical techniques for spinal deformity

Background:

  • Pedicle subtraction osteotomy (PSO) is a common surgical technique for treating sagittal spinal imbalance.
  • Complex spinal deformities, such as coronal or mixed imbalances, or severe sagittal issues, may not be amenable to a single PSO.
  • Existing literature often focuses on PSO for sagittal imbalance, with less emphasis on complex, multiplanar deformities.

Purpose of the Study:

  • To review complex spinal malalignment cases that extend beyond the scope of a single pedicle subtraction osteotomy (PSO).
  • To discuss specific surgical techniques for treating coronal imbalance, mixed imbalance, two-level PSO, vertebral column resection, and vertebral column decancellation.
  • To evaluate the role and utility of navigation in managing these complex spinal deformity cases.

Main Methods:

  • Literature review of complex spinal deformity correction techniques.
  • Analysis of case studies and surgical outcomes for various complex malalignments.
  • Discussion of the application and benefits of intraoperative navigation in challenging spinal surgeries.

Main Results:

  • Complex spinal deformities necessitate advanced techniques like vertebral column resection and decancellation.
  • Two-level PSO and navigation are crucial for managing multiplanar and severe spinal imbalances.
  • Surgical planning and execution are significantly aided by navigation in complex cases.

Conclusions:

  • Standard PSO is insufficient for many complex spinal malalignments, including coronal and mixed deformities.
  • Specialized techniques such as vertebral column resection, decancellation, and multi-level PSO are essential for treating these complex cases.
  • Intraoperative navigation plays a vital role in improving precision and outcomes for complex spinal deformity surgery.