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- •Foreword
- •Foreword
- •Original Introduction in Chinese Version
- •Introduction
- •Contents
- •Chief Editor Introduction
- •Deputy Editor Chief
- •List of Contributors
- •1.1 Ankylosing Spondylitis Osteotomy
- •Suggested Reading
- •2.1 Overview
- •Suggested Reading
- •3.1 Overview
- •3.2 Surgical Procedure
- •Suggested Reading
- •4.1 Overview
- •4.2 Surgical Procedure
- •4.4 Typical Case Presentation
- •4.4.1 Case Summary
- •4.4.2 Diagnosis
- •4.4.4 Outcome Evaluation
- •4.4.5 Expert Comments
- •Suggested Reading
- •5.1 Overview
- •5.2 Surgical Procedure
- •Suggested Reading
- •6.1 Overview
- •6.2 Surgical Procedure
- •6.4 Typical Case
- •6.4.1 Case Summary
- •6.4.2 Clinical Characteristics
- •6.4.4 Outcome Evaluation
- •6.4.5 Expert Comments
- •Suggested Reading
- •7.1 Overview
- •7.2 Surgical Procedure
- •Suggested Reading
- •8.1 Overview
- •8.2 Surgical Procedure
- •Suggested Reading
- •9.1 Overview
- •9.2 Surgical Indication
- •9.4.1 Overview
- •Suggested Reading
- •10: Hemivertebra Osteotomy
- •10.1 Overview
- •10.1.4 Inspection Method
- •10.2 Hemivertebra Osteotomy Under Halo-pelvic Traction
- •10.3.1 Indications
- •10.3.2 Contraindications
- •10.3.3 Surgical Procedure
- •10.4.3 Indications
- •10.4.4 Contraindication
- •10.4.5 Surgical Technique
- •10.4.8 Conclusion
- •10.5 Posterior Hemivertebral Osteotomy
- •10.5.2 Examination Method
- •10.5.4 Surgical Procedure
- •10.6 Posterolateral Hemivertebral Osteotomy
- •10.6.1 Surgical Procedure
- •Suggested Reading
- •11.1 Overview
- •11.2.1 Surgical Indications
- •11.2.2 Contraindications
- •11.3 Preoperative Preparation
- •11.5 Typical Case Study
- •11.6.1 Precautions
- •11.6.2 Complications Prevention
- •Suggested Reading
- •12.3 Operation Technique
- •Suggested Reading
- •13.1 Overview
- •13.1.4 Neuro Symptoms
- •13.2 Surgical Approaches
- •13.2.1 Surgical Indication
- •13.2.2 Surgical Technique
- •13.2.3 Typical Cases
- •Suggested Reading

Huizhong Tian · Yuan Ma
Jingming Xie · Yingsong Wang Editors
Spinal Osteotomy
Orthopaedics
Deformity Correction
123

Spinal Osteotomy Orthopaedics

Huizhong Tian • Yuan Ma • Jingming Xie
Yingsong Wang
Editors
Spinal Osteotomy
Orthopaedics
Deformity Correction

Editors
Huizhong Tian
Spinal Surgery
The Sixth Afliated Hospital
of Xinjiang Medical University
Urumqi, China
Yuan Ma
Spinal Surgery
The Sixth Afliated Hospital
of Xinjiang Medical University
Urumqi, China
Jingming Xie
Department of Orthopedics
The 2nd Afliated Hospital
of Kunming Medical University
Kunming, China
Associate Editors
Shaoyu Liu
Department of Orthopedics
The seventh Afliated Hospital of Sun Yat-sen
University
Shenzhen, China
Yijiang Liang
Spine Surgery
Afliated Hospital of Southwest Jiaotong
University
Chengdu, China
Zhi Zhao
Department of Orthopedics
The 2nd Afliated Hospital of Kunming Medical
University
Kunming, China
Yilihamu Tuoheti
Department of Orthopedics
The Seventh Afliated Hospital of Xinjiang
Medical University
Urumqi, China
Yingsong Wang
Department of Orthopedics
The 2nd Afliated Hospital
of Kunming Medical University
Kunming, China
Weibin Sheng
Spine Surgery
The First Afliated Hospital of Xinjiang Medical
University
Urumqi, China
Ying Zhang
Department of Orthopedics
The 2nd Afliated Hospital of Kunming Medical
University
Kunming, China
Tao Li
Department of Orthopedics
The 2nd Afliated Hospital of Kunming Medical
University
Kunming, China
Jiangtao Sui
Spine Surgery
The Sixth Afliated Hospital of Xinjiang Medical
University
Urumqi, China
Junjie Chen
Department of Orthopedics
Zhongshan People’s Hospital
Zhongshan, China
Xia Lv
Spine Surgery
The Sixth Afliated Hospital of Xinjiang Medical
University
Urumqi, China
ISBN 978-981-16-1386-9 ISBN 978-981-16-1387-6 (eBook)
https://doi.org/10.1007/978-981-16-1387-6
Jointly published with Guangdong Science & Technology Press Co., Ltd
© Guangdong Science & Technology Press Co., Ltd 2021
This work is subject to copyright. All rights are reserved by the Publishers, whether the whole or part of the material
is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting,
reproduction on microlms or in any other physical way, and transmission or information storage and retrieval,
electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publishers, the authors, and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publishers nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publishers remain neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Foreword
Spinal Osteotomy for Deformity Correction is a monograph on the research and introduction
of spinal osteotomy. The content is focused and comprehensive, and the layout is unique. The
expression and narration combined with graphics and text is concise, intuitive, and vivid. This
monograph meets the current clinical practice needs, with reference value and teaching
signicance.
The publication of Spinal Osteotomy Orthopaedics further promotes osteotomy and orthopedics, further expands the scope of the treatment of osteotomy combined with internal xation with instrumentation, and solves the problems that were difcult for treatment merely by
instrumentation in the past. It has been further accepted by spine surgeons in the clinical application of spinal osteotomy in correcting spinal deformity. In recent years, various methods of
spinal osteotomy have been reported and applied clinically, to name just a few, curetting
(decancelous or eggshell surgery) or with a burr. However, still the use of a thin-blade osteotome for osteotomy is in the minority. As circular osteotomy surrounding the dural tube with
thin- blade osteotome is technically demanding, this is a basic skill to be acquired by special
training and long-term practice. This book Spinal Osteotomy for Deformity Correction is a
tutorial for the young surgeons to master the thin-blade osteotome for spinal osteotomy.
This book emphasizes the importance of traction, osteotomy, and instrument correction for
children’s spinal curvature during development. After this golden age, it will bring difculties
to the correction of spinal deformity. It provides surgical strategies for congenital spine deformity, preventive osteotomy, and maneuver deformity correction.
A good book should be a handy tool dedicated to the reader. I believe that readers will benet from it, and improve the ability toward a high grade of spinal osteotomy.
2016.3.10
ShibiLu
Academician of the Chinese Academy of Engineering
Beijing, China
Beijing PLA General Hospital
Beijing, China
v

Foreword
In cases of ankylosing spondylitis kyphosis, spinal osteotomy is the only treatment, and it is
impossible to correct this spinal deformity without osteotomy. Therefore, spinal osteotomy
started from ankylosing spondylitis kyphosis. Spinal osteotomy was gradually applied to spinal curvature deformities due to other causes in the early 1980s. Spinal deformities such as
congenital spinal deformity, idiopathic scoliosis, tuberculosis kyphosis, traumatic kyphosis,
and degenerative scoliosis were corrected with spinal osteotomy combined with instrumentation, obtaining a better therapeutic effect than the conventional treatment by instrumentation
only for correcting spinal deformity.
Tian Huizhong and his team started this work earlier in China. On the basis of treating
kyphosis deformity of ankylosing spondylitis, they gradually developed the application of
osteotomy for the treatment of spinal deformities caused by other causes. They designed and
made the Tian’s spine osteotome through the accumulation of a large number of clinical cases.
They held the Tian’s osteotome courses in China and Japan several times and trained a large
number of young doctors using the Tian’s spine osteotome for osteotomy, because the use of a
thin-edged osteotome for osteotomy is a specialized technique that requires special training
and long-term practice. The book of Spinal Osteotomy for Deformity Correction is a handy
tool dedicated to readers. You will nd the book a great help. You will understand tacitly and
grasp the essentials of the operation with a thin-blade osteotome.
JohnChi-YanLeong
2016.3.18
Academician of Chinese Academy of Sciences
Beijing, China
Open University of Hong Kong
Ho Man Tin, Hong Kong
vii

Original Introduction in Chinese Version
Smith Petersen (1945) was the rst person to perform spinal osteotomy for ankylosing
spondylitis kyphosis (ASK). He began to use laminectomy plus manipulation to correct
ankylosing kyphosis. Meanwhile, Smith Petersen named simple laminectomy as “spinal
osteotomy.” Professor Tian Huizhong performed the rst case of ASK osteotomy at the
Xinjiang Institute of Spinal Surgery in 1961, which is the earliest case of spinal osteotomy in
China. Since then, we have entered into the era of treating ASK with simple laminectomy. But
our method is different from Smith Petersen’s. We retain spinous process and lamina and use
thin-blade osteotomy for osteotomy. The second part of this book rst introduces various
osteotomy correction techniques for kyphosis deformity of ASK (funded by the National
Natural Science Foundation of China, project number 81360280). Spinal osteotomy is the only
way to treat ankylosing spondylitis hump (ASK). Unfortunately, there is no alternative.
The internal xation technology for scoliosis correction with simple instruments has
developed rapidly, which has improved the treatment standard of spinal surgery and solved
most cases in younger age groups with smaller curvature and better compliance since
Harrington instruments were developed in the 1960s. However, it is difcult for rigid and
structural severe scoliosis to be corrected by only instrumentation such as pedicle screw and
rod system. Even the best quality instrumentation can hardly overcome the deforming force of
scoliosis. In the end, the screw will be pulled out and the rod will be broken. This is the failure
of correction as well as the source of complication. How to eliminate the deforming force of
curved spine? Osteotomy is the best way to eliminate the deforming force of curved spine and
lift the load of instrumentation. Therefore, the combination of spinal osteotomy and
instrumentation is the best choice for the treatment of spinal deformity.
This book helps the readers when they nd treating cases just with instrumentation is
difcult and cases of early-onset deformity requiring osteotomy. It is only a remedy for the
deciency of instrumentation. Through clinical application and continuous summary of
experience, the surgical methods of instrumentation and treatment scope of spinal osteotomy
are expanding. Treating deformity with osteotomy and instrumentation has got the recognition
of most colleagues, especially for children who are still developing. My team and I were
preparing to write Spinal Osteotomy for Deformity Correction to share our clinical experience
with most of our colleagues and promote the development of spinal surgery 2 years ago.
This book is a reference for colleagues. It is a continuation based on the style of osteotomy
and publication in the past 50 years while trying to illustrate with operation photos and typical
cases. We did our best to produce the anatomical and radiographic pictures involved. At the
same time, three-dimensional technology and digital medicine and simulation medicine are
introduced to explain the operation process, so that readers can get familiarized with the
relevant anatomy of the spine, and establish a good mindset to master the operation technique.
This book emphasizes the importance of traction, osteotomy, and instrumentation for spinal
deformity in children who are growing and developing. After the golden age, it will bring
difculties to the correction of the spinal deformity. It puts forward the surgical strategies for
congenital curvature of the spine, preventive early osteotomy, and correction of the deformity
of the spine.
ix

x
Original Introduction in Chinese Version
The contents of Spinal Osteotomy for Deformity Correction are divided into 4 parts and 53
chapters. The rst part is a general introduction, which mainly describes the history of spinal
osteotomy correction, spinal anatomy, biomechanics, clinical examination and diagnosis,
simulation technology, postoperative external xation, treatment of complications, and the
application of the spine osteotome. The second part is the osteotomy correction for ASK.Various
osteotomy techniques of ASK are described in detail with the combination of graphics and
texts. The third part is about the osteotomy correction of spinal deformity for other etiologies,
such as congenital, tuberculous, traumatic, degenerative, juvenile, and idiopathic tumors. The
fourth part is about other conditions operated with osteotomes, such as discectomy, spinal
canal decompression, anterior decompression of spinal cord grooving decompression with
osteotome, and so on.
This book is practical, novel, and full of pictures and texts, containing more than 1700 highdenition pictures which shows techniques and steps of each osteotomy with graphics, so as to
enable beginners to master surgical techniques quickly. References are attached at the end of
each chapter for the reader’s reference.
Thank you very much for the help and support of colleagues and experts in the process of
compiling this book. Special thanks to Academician ShibiLu and John Chi-Yan Leong for their
guidance and review despite their busy schedules, which makes this book perfect. Our thanks
also go to the Sixth Afliated Hospital of Xinjiang Medical University and the Second
Afliated Hospital of Kunming Medical University for the support and encouragement. We
also thank Liang Zhou, Vice-President of Guangdong Science and Technology Publishing
House, for his planning and guidance despite his busy schedule, so that the book can be brought
to readers at an early date.
Due to the restriction of time and limitation of the author, this book might still contain
unavoidable errors. We ask for criticism and correction by readers. The illustrations cited are
listed in the references in the compilation of this book. As for any missing information please
contact the authors of this book.
HuizhongTian
2016-3-27
YuanMa
JingmingXie

Introduction
Spinal Osteotomy for Deformity Correction is a monograph of introducing osteotomy for spinal deformity correction surgery. Its content is prominent and comprehensive. The unique
arrangement with the combination of pictures and text is concise, intuitive, and vivid. It is a
monograph for the needs of current clinical practice with reference value and teaching signicance. The publication of Spinal Osteotomy for Deformity Correction expands the scope of
application of osteotomy and the combined treatment with osteotomy and internal xation. It
solves the difcult problems treated only by simple instruments in the past and made spinal
osteotomy further recognized by spinal surgeons in clinical application.
The Chinese version of Spinal Osteotomy for Deformity Correction was published by
Guangdong Science and Technology Press in October 2018, including 4 articles and 53 chapters. The English version of Spinal Osteotomy for Deformity Correction was published by
Springer, which is published in two volumes. The rst volume is on spinal deformity osteotomy which consists of 13 chapters, including “History of the Development of Spinal
Osteotomy,” “Application of Tian’s Spinal Osteotomes,” “Transverse Laminectomy for
Ankylosing Spondylitis Kyphosis,” “V-Shape Laminectomy for Ankylosing Kyphosis,”
“Pedicle Subtraction Osteotomy for Ankylosing Kyphosis Deformity,” “Vertebral Column
Resection for Ankylosing Spondylitis Kyphosis,” “Non-apex Osteotomy for ASK,” “Apex
Osteotomy for AS Kyphosis,” “Spinal Osteotomy for Congenital Angular Kyphosis,”
“Hemivertebra Osteotomy,” “Osteotomy for Tuberculosis Angular Kyphosis,” “Posterior
Vertebral Column Resection (PVCR) Correction for Severe Rigid Spinal Deformity,” and
“Osteotomy for Traumatic Spinal Deformity.” They are various surgical methods of spinal
osteotomy with Tian’s osteotomes and also described in detail by pictures and text.
The feature of this book is to illustrate the method of surgical operation to achieve the purpose of enabling beginners to quickly grasp the surgical skills. A good book is a set of handy
tools dedicated to the reader. We believe that readers will benet from it and improve the ability and application level of spinal osteotomy and surgery.
We would like to express our deep appreciation to all the colleagues and experts for their
great assistance and support in the translation and editing of this book! Thanks to the Sixth
Afliated Hospital of Xinjiang Medical University and the Second Afliated Hospital of
Kunming Medical University for their strong support and encouragement! Thanks to Zhou
Liang, vice president, and Zeng Chong, editor of Guangdong Science and Technology Press,
for your support! We would also like to thank Hu Bin, editor of Springer Press, and Jiao
Guohui, editor of Springer, for taking time out of your busy schedules to plan and guide the
book, so that it can be brought to the readers as soon as possible.
HuizhongTian
2020-11-25
YuanMa
JingmingXie
YingsongWang
xi

Contents
1 History of the Development of Spinal Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Huizhong Tian, Yuan Ma, Jingming Xie, Yingsong Wang, and Xia Lv
2 Application of Tian’s Spinal Osteotomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Huizhong Tian, Yuan Ma, and Xia Lv
3 Transverse Laminectomy for Ankylosing Spondylitis Kyphosis . . . . . . . . . . . . . . 21
Huizhong Tian, Jiangtao Sui, and Ying Zhang
4 V-Shape Laminectomy for Ankylosing Kyphosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Huizhong Tian, Zhi Zhao, and Ni Bi
5 Pedicle Subtraction Osteotomy for Ankylosing Kyphosis Deformity . . . . . . . . . . . 47
Huizhong Tian, Tao Li, and Zhibo Song
6 Vertebral Column Resection for Ankylosing Spondylitis Kyphosis . . . . . . . . . . . . 57
Huizhong Tian, Yuan Ma, and Jingming Xie
7 Non-apex Osteotomy for ASK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Yingsong Wang, Ying Zhang, and Huizhong Tian
8 Apex Osteotomy for AS Kyphosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Yijian Liang, Shaoyu Liu, Huizhong Tian, and Junyi Ma
9 Spinal Osteotomy for Congenital Angular Kyphosis . . . . . . . . . . . . . . . . . . . . . . . . 107
Huizhong Tian, Weibin Sheng, Yilihamu Tuoheti, Li Li, and Junyi Ma
10 Hemivertebra Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Huizhong Tian, Junjie Cheng, Tao Li, Zhibo Song, Zhiyue Shi,
Zhi Zhao, Xu Zhu, Jie Dai, Junyi Ma, Jiangtao Sui, Weibin Sheng,
Shaoyu Liu, and Quan Li
11 Osteotomy for Tuberculosis Angular Kyphosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Huizhong Tian, Sikandaer Siyiti, Quan Li, Zhiyue Shi, Jie Dai, Xu Zhu,
Yingsong Wang, Ni Bi, and Li Li
12 Posterior Vertebral Column Resection (PVCR) Correction
for Severe Rigid Spinal Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Jingming Xie
13 Osteotomy for Traumatic Spinal Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Huizhong Tian, Yuan Ma, Yingsong Wang, and Li Li
xiii
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