The True Ponte Osteotomy: By the One Who Developed It

Abstract

Study design: Technique and applications.

Objectives: To define the anatomy, biomechanics, indications, and surgical technique of the true Ponte osteotomy.

Summary of background data: The Ponte osteotomy, originally developed for thoracic kyphosis, was the first one to obtain posterior shortening of the thoracic spine, maintaining the anterior column load-sharing capacity. It has become a widely applied technique in various types of spine deformities and a frequent topic of presentations at meetings and in scientific articles. Several of them offer unquestionable evidence of an incorrect execution, with consequently distorted outcomes and erroneous conclusions. A clearing up became essential.

Methods: Our original experience is based on a series of 240 patients with thoracic hyperkyphosis operated in the years 1969-2015, at first with a standard posterior Harrington technique and then by using the Ponte osteotomy with different instrumentations. A series of 78 of them, operated in the years 1987-1997, who had Ponte osteotomies at every level, is presented.

Results: The average preoperative kyphosis has been corrected from 80° (range 61°-102°) to 31° (range 15°-50°) by a substantial posterior shortening.

Conclusions: A number of publications use the term Ponte osteotomy loosely for by far incomplete resections and mixing it up with Smith-Petersen's osteotomy. The true Ponte osteotomy is capable of producing marked flexibility in extension, flexion and rotation, justifying its wide use in thoracic deformities, mainly in scoliosis. An exact performance of the osteotomy with adequate bony resections, including the laminae, is an absolute condition to take full advantage of its properties.

Level of evidence: Level IV, therapeutic study.

Keywords: Ankylosing spondylitis; Flexibility; Kyphoscoliosis; Ponte osteotomy; Posterior column shortening; Scoliosis; Smith-Petersen osteotomy; Thoracic kyphosis.