Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep;9(5):1411-1418.
doi: 10.1007/s43390-021-00339-x. Epub 2021 Apr 16.

Ponte osteotomies in a matched series of large AIS curves increase surgical risk without improving outcomes

Lorena V Floccari  1 , Kiley Poppino  2 , Dustin A Greenhill  3 , Daniel J Sucato  4
Affiliations

Ponte osteotomies in a matched series of large AIS curves increase surgical risk without improving outcomes

Lorena V Floccari et al. Spine Deform. 2021 Sep.

Abstract

Purpose: The routine use of Ponte osteotomies in adolescent idiopathic scoliosis (AIS) surgery is controversial with conflicting data for coronal plane correction and little analysis in the sagittal plane. The objective of this study was to analyze the efficacy of Ponte osteotomies in large curve AIS.

Methods: A single institution, prospectively-collected series of consecutive AIS patients who had Ponte osteotomies (P cohort) was directly matched to patients with no Pontes (NP cohort) by age, gender, Lenke classification, surgeon, coronal, and sagittal Cobb angles. The radiographic review included adjusted values using a 3D-derived published formula for preoperative T5-T12 kyphosis. Patient-reported outcomes (PROs) were assessed with the SRS-30 and Spinal Appearance Questionnaire (SAQ).

Results: There were 68 patients (34/cohort) with minimum 2-year follow-up with no differences between P and NP cohorts in age, preoperative coronal Cobb (74.5° vs 70.8°), flexibility index, measured or 3D-adjusted T5-T12 kyphosis. Rod material/diameter, fusion levels, blood loss, and operative time did not differ, but implant density was higher in the P group (1.53 vs 1.31, p < 0.001). The P group had 7.9% greater coronal Cobb correction (66.6% vs 58.7%, p < 0.003) without difference in final Cobb angles (24.7° vs. 29.1°, p = 0.052). There were no differences in measured or adjusted T5-T12 kyphosis in the sagittal plane. The P group had a 15% rate of critical intraoperative neuromonitoring changes versus 0% in the NP group (p = 0.053). At follow-up, there were no differences in scoliometer measurements or any domain of SRS-30 or SAQ scores.

Conclusion: In this first reported matched series of AIS patients, Ponte osteotomies provide small radiographic gains in the coronal plane with no improvement in the sagittal plane and no change in truncal rotation. There was a higher risk of critical intraoperative neuromonitoring changes, and no benefits in patient-reported outcomes. This calls into question the routine use of Ponte osteotomies in AIS, even for curves averaging 70 degrees.

Level of evidence: II.

Keywords: AIS; Adolescent idiopathic scoliosis; Osteotomy; Ponte; Posterior spinal fusion.

PubMed Disclaimer

References

    1. Smith-Petersen MN, Larson CB, Aufranc OE (1969) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res 66:6–9 - PubMed
    1. Ponte A (1985) Surgical treatment of Scheuermann’s hyperkyphosis. Orthop Trans 9:127
    1. Ponte A (2003) Posterior column shortening for Scheuermann’s kyphosis. An innovative one-stage technique. J Spinal Disord Tech. 20:586–593
    1. Ponte A, Orlando G, Siccardi GL (2018) The true ponte osteotomy: by the one who developed it. Spine Deformity 6(1):2–11. https://doi.org/10.1016/j.jspd.2017.06.006 - DOI - PubMed
    1. Geck MJ, Macagno A, Ponte A, Shufflebarger HL (2007) The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech 20(8):586–593. https://doi.org/10.1097/BSD.0b013e31803d3b16 - DOI - PubMed

Publication types

LinkOut - more resources