Decompressive Osteotomy

When this procedure may be recommended

• Severe spinal deformity (such as sagittal imbalance, flatback syndrome, or severe scoliosis) causing debilitating pain.
• Multi-segment spinal stenosis with associated spinal instability or fixed sagittal misalignment.
• Inability to stand upright or look straight ahead due to fixed spinal deformity.
• Failed prior spine surgeries with progressive sagittal or coronal decompensation.

Who may be a candidate

Candidates are typically patients with rigid, fixed spinal deformities causing severe chronic pain, myelopathy, or progressive neurological deficit who have failed comprehensive non-surgical options. Ideal candidates must have sufficient bone density to support complex reconstruction and have their cardiovascular and medical status thoroughly optimised for a major spinal reconstruction.

Advanced medical implant technology (no text).

Alternatives to surgery

• Conservative multidisciplinary pain management, including physical therapy, custom orthotic bracing, and targeted injections.
• Less invasive decompressive surgery without deformity correction (only if deformity is not the primary driver of symptoms and stability can be maintained).
• Pain specialist referral for advanced neuromodulation (e.g., spinal cord stimulation) or intrathecal therapy.

What to expect

1. Preparation: The patient is placed under general anaesthesia with continuous, comprehensive multi-modality motor and sensory intraoperative neuromonitoring (MEP/SSEP).
2. Exposure: A posterior midline incision is made over the pre-planned spinal segments to expose the vertebral column.
3. Instrumentation: Pedicle screws are placed at multiple levels above and below the planned osteotomy site to act as anchor points.
4. Decompression & Osteotomy: A precise wedge of bone is cut and removed from the target vertebra (e.g., Smith-Petersen osteotomy or Pedicle Subtraction osteotomy) to expose and decompress the spinal canal and nerve roots.
5. Deformity Correction: The spine is carefully closed down across the osteotomy gap or realigned, using specialised rods to achieve the calculated sagittal and coronal balance.
6. Stabilisation & Fusion: Bone graft is packed along the instrumented levels to promote long-term solid bony fusion, and the wound is closed in layers over deep drains.

Technology and imaging

Performed under continuous multi-channel intraoperative neuromonitoring (MEP/SSEP), with high-resolution fluoroscopy, computer-guided surgical navigation, and specialised bone-cutting tools to ensure maximum safety.

High-precision diagnostic imaging visualization.

Clinical Zeiss/Leica operating microscope setup.

Hospital stay

Typically 5 to 7 nights in hospital, including initial monitoring in the High Dependency Unit or Intensive Care Unit.

Recovery milestones

• Immediate: Gentle mobilisation with physiotherapy starts within 24 to 48 hours, supported by customised bracing if required.
• Weeks 1-6: Focus on pain management, careful walking on flat surfaces, and surgical wound healing. Strict avoidance of bending, lifting, or twisting is required.
• Months 3-6: Gradual progress in active rehabilitation. X-rays are performed at intervals to assess early bone healing and fusion progress.
• Months 12+: Complete solid bony fusion is typically achieved, allowing a gradual return to moderate physical activities.

Post-operative mobilization and recovery milestones.

Risks and complications

• Neurological injury, including temporary or permanent weakness or numbness in the legs (1% to 3% risk).
• Cerebrospinal fluid (CSF) leak or dural tear.
• Non-union or pseudarthrosis (failure of bone fusion, which may require revision surgery).
• Hardware failure, screw loosening, or rod breakage before solid fusion is achieved.
• Wound infection, deep vein thrombosis (DVT), or pulmonary embolism.

Frequently asked questions