Search

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., (Copyright © 2020 by the Congress of Neurological Surgeons.)

This surgical video demonstrates the technique of an anterior lumbar interbody fusion (ALIF). This video demonstrates the surgical approach, technical nuances of ALIF, and pearls. The main surgical anatomy and approach-related risks are discussed. The video demonstrates the nuances of ALIF, discussing the importance of the release of the disc space to allow for height restoration and lordosis, endplate preparation to enhance arthrodesis, and choice of implant size. The incision is made via a left paramedian approach with a retroperitoneal dissection and mobilization of the vasculature for access to the disc space. The ALIF provides direct access to the ventral surface of the exposed disc, allowing for an incision of the anterior longitudinal ligament, bilateral release of the annulus fibrosus, and access to a large surface area of the vertebral endplate. This anterior access allows for the placement of implants with a greater surface area for fusion, and this facilitates restoration of segmental lordosis, disc height improvement, and foraminal height increase. We have received informed consent from this patient for the video of this case., (Copyright © 2020 by the Congress of Neurological Surgeons.)