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Updated: Apr 20, 2026
Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
Published on: September 16, 2022
Osteotomies in proximal junctional kyphosis in the cervicothoracic area
R Cecchinato1, P Berjano, R Bassani
12nd Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy, r.cecchinato@hotmail.it.
Introduction:
Proximal junctional kyphosis (PJK) of the cervicothoracic spine is a deformity that can affect patients who have undergone long thoracolumbar instrumented fusion. Preoperative hyperkyphosis of the thoracic spine and changes of more than 30° in lumbar lordosis are independent risk factors for the onset of PJK.
Methods:
When PJK occurs in the cervicothoracic spine, extension of the fusion with eventual application of osteotomy techniques is frequently necessary to treat symptomatic patients or in case a neurological deficit occurs. Ponte osteotomy and pedicle subtraction osteotomy (PSO) are the two most used techniques to restore a good cervicothoracic alignment, although they are still demanding procedures even for expert surgeons. In junctional fractures, a vertebral column resection can be performed to support the anterior column. Ponte osteotomy ideally restores 10° at each treated level, while PSO allows a segmental correction up to 30°-35°. Adequate preoperative planning is fundamental for outlining the correct surgery and choosing the appropriate osteotomy.
Conclusions:
The aim of corrective surgery is to restore the cervicothoracic alignment, obtaining an adequate postoperative sagittal balance and decreasing the risk of further complications and new revision surgeries.
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