A Review of Indications, Surgical Technique, and Outcomes for the Cervical Pedicle Subtraction Osteotomy

Cervical spine deformity is a debilitating condition that can be challenging to treat. For patients with fixed, focal, kyphotic deformities near the cervicothoracic junction, a pedicle subtraction osteotomy (PSO) can be considered. Classifying a given cervical spine deformity and quantifying the mismatch between current and desired alignment are critical steps in determining whether a PSO should be done. It is also important to understand the relative contraindications for a cervical PSO and the radiographic and patient-reported outcomes associated with the procedure. Here, we review these topics and the details of our surgical technique and postoperative considerations. Specific nuances of the setup, exposure/approach, osteotomy, closure, and postoperative protocol are highlighted. A surgical video is also included (Video 1). Our aim is to provide a conceptual framework for understanding when a cervical PSO should be considered, how it can be performed effectively, and the outcomes that can be expected.