Lebl, MD. Because the spine and pelvis are integrated, changes in spine sagittal balance affect relative acetabulum position.
Threecolumn spine osteotomies correct fixed sagittal plane deformity. Twenty patients with kyphotic deformity and associated sagittal imbalance underwent corrective 3-column osteotomy. We reviewed upright pelvic and spine radiographs preoperatively and postoperatively and documented the changes in angles.
Spinal osteotomies: indications, limits and pitfalls
The average sagittal vertical axis was Complications after consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Lawrence G Lenke , Peter O.
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Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of patients. Vertebral column resection in children with neuromuscular spine deformity. Apical segmental resection osteotomy with dual axial rotation corrective technique for severe focal kyphosis of the thoracolumbar spine. Vertebral column decancellation for the management of sharp angular spinal deformity Yan Wang , Lawrence G Lenke. Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients.
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Lawrence G Lenke , Patrick T. Anatomically, a certain amount of decompression is required when performing an osteotomy and this is reflected within the osteotomy code - the laminectomy is an integral part of a posterior column osteotomy and it is necessary to protect the nerves while correcting the deformity.
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Thus, a surgeon cannot code for both a decompressive laminectomy and an osteotomy at the same site. Today, Smith-Petersen and Ponte osteotomies are synonymous and used interchangeably. Thus, in coding an adult scoliosis spinal fusion case from TS1 with bilateral iliac screws where inferior facetectomies were performed, the proper codes used would be: multiple level posterior arthrodesis for deformity, segments , posterior segmental spinal instrumentation, vertebrae, 8 vertebrae , Instrumentation into the ilium , posterior iliac crest bone graft via a separate fascial incision.
What is a Posterior Column Osteotomy?
Whereas, a degenerative adult hypolordotic scoliosis with limited flexibility with a planned posterior fusion from TS1 with iliac screws that requires multiple posterior osteotomies from L1-L5 to obtain lordosis is coded with the posterior osteotomy codes. The posterior column osteotomies, Smith-Petersen or Ponte types, require the complete removal of the intervening ligamentum flavum, and both the inferior and superior facets bilaterally at each osteotomy site.
This case example would be coded:. Chair: Christopher J. Haynes, MD.
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