Study Design. Retrospective review. Objective. To report the technique and results of vertebral column decancellation (VCD) for the management of sharp angular spinal deformity. Summary of Background Data. The goal of management of sharp angular spinal deformity is to realign the spinal deformity and safely decompress the neurological elements. However, some shortcomings related to current osteotomy treatment for these deformities are still evident. Methods. From January 2004 to March 2007, 45 patients (27 males/18 females) with severe sharp angular spinal deformities at our institution underwent VCD. The diagnoses included 29 congenital kyphoscoliosis and 16 Pott's deformity. The operative technique included multilevel VCD, disc removal, osteoclasis of the concave cortex, compression of the convex cortex accompanied by posterior instrumentation with pedicle screws. Preoperative and postoperative radiographic evaluation was performed. Intraoperative, postoperative and general complications were noted. Results. For a kyphosis type deformity, an average of 2.2 vertebrae was decancellated (range, 2to 4 vertebrae). The mean preoperative kyphosis was +98.6° (range, 82° to 138°), and the meankyphosis in the immediate postoperative period was +16.4° (range, 4° to 30°) with an averagepostoperative correction of +82.2° (range, 61° to 124°). For a kyphoscoliosis type deformity, thecorrection rate was 64% in the coronal plane (from 83.4° to 30.0°) postoperatively and 32.5°(61% correction) at 2 years follow-up. In the sagittal plane, the average preoperative curve of88.5° corrected to 28.6° immediately after surgery and to 31.0° at 2 years follow-up. All patientshad solid fusion at latest follow-up. Complications were encountered in 8 patients (17.8%) andincluded transient neurological deficit and complete paralysis (n = 1). Conclusion. Single stage posterior vertebral column decancellation (VCD) is an effective option to manage severe sharp angular spinal deformities

Purpose. compare the radiological results in sagittal balance correction obtained with pedicle subtraction osteotomy (PSO) versus anterior-posterior osteotomy (APO) by double approach in adults. Material and Methods. between January of 2001 and July of 2009, fifty-eight vertebral osteotomies were carried out in fifty-six patients: 9 Smith-Petersen osteotomy (SPO), one vertebral resection osteotomy (VRO), 30 anterior-posterior osteotomies (APO) and 18 pedicle subtraction osteotomies (PSO), being the lasts two groups the sample studied (48 osteotomies). The mean age of the patients was 56.3 years (17–72). Initial diagnose was: 28 posttraumathic kyphosis, 7 postsurgical kyphosis, 7 adult degenerative disease, 4 ankylosing spondylitis and 2 congenital kyphoscoliosis. We evaluated the preoperative standing radiographs, the postoperative and at final follow-up by digital measurements with iPACS system viewer (© Real Time Image, USA, 2001). The mean follow-up was 54 months (6–98), and complications were analized. Results. The group APO had a mean preoperative thoracic kyphosis of 67 °, a mean lumbar lordosis of −42° and a mean sagital balance of 8.6°. The group PSO had a mean preoperative thoracic kyphosis of 41°, a mean lumbar lordosis of −22° and a mean sagital balance of 12.3°. The mean correction in the APO group was 29° in its thoracic kyphosis, 8° of lumbar lordosis and 6.5° in its sagital balance. The mean correction in the PSO group was 12° of the thoracic kyphosis, 25 in the lumbar lordosis and 8.4 cm in the sagital balance. The local correction obtained at the osteotomy level was 28° in the APO group and 25.3° in the PSO group. There were no statistically significant differences in the percentage of correction between both groups (p>0.05). In terms of complications, PSO group had lower complication rate (26.6%) comparing to ODV group (44.5%). Conclusions. APO and PSO are useful techniques to correct the global sagital balance in patients with a disturbance of the sagittal profile. The correction obtained with the PSO is similar to obtained with the APO. Patients undergoing an OSP had a lower complication rate than patients undergoing APO