Two-stage spinal osteotomy combined with lateral lumbar interbody fusion for lumbar kyphosis: illustrative case

BACKGROUND Adult spinal reconstructive surgery that requires multilevel spinal fusion is highly invasive and requires two-stage surgery using lateral lumbar interbody fusion (LLIF) and/or percutaneous pedicle screw (PPS) fixation to make it less invasive. However, it is still difficult to make spinal osteotomy less invasive, and the high complication rate is an issue. OBSERVATIONS The authors present the surgical techniques of a two-stage Schwab grade 4 spinal osteotomy using LLIF, which could reduce surgical invasiveness and enable good correction and anterior spinal column reconstruction for lumbar kyphosis, and also report a case treated with this procedure. The first surgery consisted of L2-5 LLIF and L6-S1 posterior lumbar interbody fusion with temporary PPS fixation. The second surgery, 2 weeks after the first surgery, was a grade 4 osteotomy performed in the L4 vertebral body at a 30 degrees angle toward the center of the LLIF cage between L3 and L4, followed by PPS fixation from T10 to the pelvis and additional fixation with two collateral rods. LESSONS Two-stage grade 4 osteotomy using LLIF could reduce invasiveness and blood loss while providing good anterior support. This surgical method is expected to make spinal reconstruction surgeries requiring osteotomy less invasive.