The patient required multiple posterior osteotomies (called “Smith-Peterson” or “Ponte Osteotomies”) to straighten their spine to normal degrees of kyphosis. Normally the vertebra contact each other through 3 joints at each level: one disc in the front, and two sliding facets in the back. In the thoracic spine, the facets look like shingles on a roof, and will only allow you to bend backward so far. In this osteotomy, we remove the facets and bend the spine backward further than normal. Over one level, only a little bit of correction will occur (5-15 degrees). However, over many levels, large amounts of correction can be achieved.
The patient required a vertebral column resection to take the pressure of their nerves. This is the most powerful and dangerous procedure that can be performed on the spine (especially in a 5 year old!). Essentially, an entire vertebra or more are removed from the back of the spine. This dislocates the spine so it can be repositioned properly.