(I-616) Intradiscal Osteotomy (IDO): High Resolution Technique Guide and Single Institute Experiences Using Expandable Interbody Devices in Complex Spinal Pathology
Fellow Cedars-Sinai Medical Center York, Pennsylvania, United States
Introduction: As the number of spinal fusion procedures has risen over the past few decades there has also been a reported decrease in the utilization of three column osteotomies. Many surgeons are familiar with the traditional posterior spinal osteotomy classification; however, a lesser-known osteotomy, the bone-disc-bone osteotomy, exists outside of this classification. We present the “intradiscal osteotomy” (IDO) technique, a type of bone-disc-bone, less-invasive three-column osteotomy that utilizes expandable interbody devices to achieve all-posterior correction of complex spinal pathology.
Methods: A fresh-frozen cadaver was prepared for demonstration of the IDO technique in the mid-lumbar spine. The procedure was documented through serial, high-resolution photographs in stepwise progression. Standard fluoroscopy was used to document the procedure’s corrective ability. Additionally, a narrative case series was chosen from within a single institute to demonstrate the procedure’s utility and feasibility in a variety of complex spinal clinical scenarios.
Results: Intradiscal osteotomy with the use of expandable interbody devices was successfully demonstrated on a cadaveric model. A high-resolution technique guide was produced through serial photographs. Our narrative case series demonstrates the IDO’s utility and feasibility in complex spinal pathology; specifically, correction of cervicothoracic and thoracolumbar adult spinal deformity (ASD), proximal junctional failure (PJF), distal junctional failure (DJF), isthmic spondylolisthesis, and pseudarthrosis. We additionally demonstrate its feasibility in iatrogenic flat-back syndrome through an all-posterior, attritional release of the anterior longitudinal ligament (ALL).
Conclusion : The intradiscal osteotomy combined with expandable interbody devices can achieve powerful correction without the use of more invasive three column osteotomies. Surgeons may find this technique desirable and rapidly adoptable due to its similarity to a traditional transforaminal interbody fusion. Our technique guide and narrative case series is meant to assist surgeons looking for alternatives to traditionally described three column osteotomies.
