Posterior-Based Management of Spinal Deformity

A comprehensive understanding of the indications and techniques for posterior-based management of spinal deformity is critical for optimal surgical management of adult deformity. The importance of sagittal and coronal balance in pain and disability in adult deformity is well-established. Anterior column reconstruction is an increasingly used adjunct for the treatment of deformity. However, posterior-based strategies remain invaluable and can be used for adult scoliosis, flatback syndrome, iatrogenic fixed sagittal imbalance, and kyphotic decompensation syndrome. This chapter will review posterior-based management strategies for adult spinal deformity, including posterior spinal osteotomies and their indications, techniques, outcomes, and complications. The Schwab anatomic osteotomy classification is a useful and reliable tool for standardizing the nomenclature of these osteotomies, with a high interobserver reliability ( Fig. 148.1 ). Surgery for the treatment of scoliosis in the adult is appropriate for patients with refractory pain, curve progression, or neurological deficit leading to significant impairment in quality of life. The purpose of this chapter is to review posterior-based surgical strategies for the management of spinal deformity.

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Schematic representation of the Schwab anatomic osteotomy classification. Increasing grade is associated with greater bony removal, destabilization, and potential for deformity correction.

Modified from Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 2014;74(1):112-120.