Posterior Column Osteotomy of the Lumbar Spine: 2-Dimensional Operative Video

The posterior column osteotomy (PCO) is a tool for correction in spinal deformity. It allows for the induction of lordosis and coronal plane correction. It can be performed at multiple levels to loosen and mobilize the spine. Although the PCO does not provide as much correction as a 3-column osteotomy, it can be done in less operative time and with less morbidity. Performing a PCO involves the resection of posterior bony elements, including entire facet complexes, the ligamentum flavum, and at least part of the lamina. The ligamentum flavum laterally is also resected, and the exiting nerve roots are skeletonized bilaterally. Compression of the osteotomy can cause foraminal stenosis, and it is important to ensure that the exiting nerve roots are adequately decompressed to avoid potential postoperative radiculopathy. The authors present an illustration of the technique with saw bones, a clinical case describing the use of PCOs, and an intraoperative video of a PCO performed at L5-S1. The patient consented to the surgical procedure and video/image recording for possible publication purposes prior to the operation being performed.