What is the preferred level for performing a Smith Petersen lumbar osteotomy

The preferred level for Smith-Petersen osteotomy for AS deformity is the L3-L4 level. The posterior elements are removed with the apex of the osteotomy at the L3-L4 disc space. The L3-L4 level is located at the normal center of lumbar lordosis, below the termination of the conus medullaris. The spinal canal area is relatively capacious at this level. These factors decrease the neurologic risk of an osteotomy procedure at L3-L4, compared with osteotomy at proximal spinal levels, where the presence of the distal spinal cord and conus within the spinal canal increases the risk of neurologic injury. MRI and/or CT scans should be obtained to evaluate the spinal canal preoperatively and to assess for spinal stenosis.

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