General:
- The SRS-Schwab classification nomenclature grades osteotomies from 1 to 6 by the amount of bone or disc removal
- The description will be like Grade 2 osteotomy with Anterior release: Grade 2 A/P
Grade
Aka
Anatomic Resection
Description
Surgical Approach
Grade 1 osteotomy
Smith-Petersen osteotomy (SPO)
Opening-wedge osteotomy
Chevron osteotomy
Extension osteotomy
Opening-wedge osteotomy
Chevron osteotomy
Extension osteotomy
Partial facet joint
Resection of the inferior facet and joint capsule at a given spinal level
5-10deg of correction can be achieved at each level, but a lack of anterior column mobility can lead to vascular and neurological sequelae
5-10deg of correction can be achieved at each level, but a lack of anterior column mobility can lead to vascular and neurological sequelae
P (posterior approach only)
Grade 2 osteotomy
Ponte osteotomy
Complete facet joint
Both superior and inferior facets at a given spinal segment are resected with complete ligamentum flavum removal.
Other posterior elements of the vertebra including the lamina, and the spinous processes may also be resected
Other posterior elements of the vertebra including the lamina, and the spinous processes may also be resected
P (posterior approach only)
A/P (anterior soft tissue release combined with posterior resection)
A/P (anterior soft tissue release combined with posterior resection)
Grade 3 Osteotomy
Pedicle subtraction osteotomy (PSO)
Closing wedge osteotomy
Transpedicular wedge resection
Closing wedge osteotomy
Transpedicular wedge resection
Pedicle/partial body
Partial wedge resection of a segment of the posterior vertebral body and a portion of the posterior vertebral elements with pedicles
25 - 35deg of correction can be reasonably achieved at any given level
25 - 35deg of correction can be reasonably achieved at any given level
P (posterior approach only)
A/P (both)
Grade 4 Osteotomy
Extended PSO-into disc space
modified Smith-Petersen osteotomy
modified Smith-Petersen osteotomy
Pedicle/partial body/disc
Wider wedge resection through the vertebral body; includes a substantial portion of the posterior vertebral body, posterior elements with pedicles, and includes resection of at least a portion of 1 endplate with the adjacent intervertebral disc
P (posterior approach only)
A/P (both)
Complete vertebra and discs
Complete removal of a vertebra and both adjacent discs (rib resection in the thoracic region)
Tiny rim of bone left at anterior vertebral body to protect the great vasculature
Tiny rim of bone left at anterior vertebral body to protect the great vasculature
P (posterior approach only)
A/P (both)
Grade 6 osteotomy
Extended VCR
Multiple vertebrae and discs
Resection of more than one entire vertebra and adjacent discs. Grade 5 resection and additional adjacent vertebral resection
P (posterior approach only)
A/P (both)
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