Current concepts and management of patients with fixed decompensated spinal deformity

The patient with a fixed decompensated spine deformity presents a difficult orthopaedic challenge. Consideration of the potential risks and benefits is critical with these patients before embarking on a significant surgical procedure. The deformity should be evaluated according to coronal, sagittal, and axial planes, with consideration given to where the major deformity exists. For deformities which exist in the sagittal plane only, a single stage posterior decancellation, known as the eggshell procedure, and posterior spinal fusion are preferred, rather than a 2 stage combined anterior and posterior approach. For deformities in the coronal plane, which are often associated with sagittal and axial malalignment, combined approaches are preferable for correcting imbalance. However, for severe, multiplane deformities where multiple osteotomies and recorrection are unlikely to safely produce balance, vertebral body resection with spinal shortening would be preferable. The authors' experience in treating fixed, decompensated spinal deformities is presented herein.