The role of posterior spinal osteotomies in pediatric spinal deformity surgery: indications and operative technique.

The primary goals of spinal deformity surgery are to prevent the progression of further deformity and to improve sagittal and coronal balance. Although increasingly powerful instrumentation has greatly facilitated these treatment goals, osteotomy of the spine is sometimes necessary to address more significant deformity. This review provides a detailed overview of posterior spinal osteotomies, which have gained increased attention as an adjunct to the treatment of complex pediatric spine deformity. The indications, operative technique, and advantages and disadvantages of the Smith-Petersen, pedicle subtraction and vertebral column resection osteotomies will be discussed, as well as operative considerations generally applicable to spinal deformity surgery involving correction with osteotomies.