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Updated: Dec 22, 2025

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Pedicle Subtraction Osteotomy.

Munish C Gupta1, Sachin Gupta2, Michael P Kelly1

  • 1Washington University School of Medicine, Saint Louis, Missouri.

JBJS Essential Surgical Techniques
|May 6, 2020
PubMed
Summary
This summary is machine-generated.

Pedicle subtraction osteotomy (PSO) corrects sagittal plane deformities by removing posterior elements and creating a wedge to shorten the spine. This safer technique is ideal for rigid, flat lumbar spines, especially after multiple fusions.

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Area of Science:

  • Spine surgery
  • Orthopedic surgery
  • Surgical techniques

Background:

  • Pedicle subtraction osteotomy (PSO) was initially developed for ankylosing spondylitis due to safety concerns with anterior column lengthening.
  • PSO involves posterior element removal and vertebral body wedging for spinal shortening and sagittal correction.
  • It is now used for various sagittal plane deformities, including those from degenerative conditions or prior surgeries causing lumbar lordosis loss.

Purpose of the Study:

  • To describe the technique and indications for pedicle subtraction osteotomy (PSO).
  • To highlight PSO's role in correcting sagittal plane deformities in diverse spinal conditions.
  • To emphasize PSO's advantages in specific patient populations, such as those with rigid, flat lumbar spines.

Main Methods:

  • PSO involves pedicle screw fixation above and below the osteotomy level.
  • Posterior elements are decompressed, and the vertebral body is decancellated and decorticated.
  • Correction is achieved by impacting the posterior vertebral wall and manual manipulation to restore lordosis, followed by rod fixation.

Main Results:

  • PSO allows for sagittal plane correction, with potential for up to 40° correction in flat lumbar spines.
  • Asymmetric PSO can address coronal plane deformities.
  • Advancements in instrumentation and techniques have increased PSO's frequency and efficacy.

Conclusions:

  • Pedicle subtraction osteotomy is an effective technique for correcting significant sagittal plane deformities.
  • It offers a safer and more direct approach compared to historical methods.
  • PSO is particularly beneficial for patients with rigid spines and a history of multiple spinal fusions.