Decorticating and Grafting Technique in Posterior Instrumented Spinal Fusion for Idiopathic Scoliosis Correction Surgery

The success rate of spinal deformity correction surgeries relies on a robust long-term vertebral arthrodesis. However, the non-union rate in spinal fusion for lumbar or thoracic deformities is still high, despite the recent advances in implant design, surgical techniques, and bone grafting technology. Meticulous and thorough decortication is of great importance, while bone grafting is considered to enhance the fusion rate, improving the results of these procedures. The aim of this technical note is to thoroughly describe in a stepwise fashion a surgical technique for complete midline and lateral posterior decortication and bone grafting in posterior instrumented spinal fusion surgery for scoliosis deformity correction surgery. Critical steps of decortication include obliteration of the facet joints and decortication of the surfaces of the pars interarticularis, lamina, later aspects of the articulating facets, and transverse processes (TPs), as well as removal of all the excessive surrounding soft tissues. For bone grafting, the spinous processes of the vertebrae are hemi-sectioned at the base, divided in half, while a novel ceramic bio-glass is also used as a graft expander. Moreover, recent literature regarding posterior elements decortication and bone grafting in posterior instrumented spinal fusion is presented.