One-Stage Posterior Multiple-Level Asymmetrical Ponte Osteotomies Versus Single-Level Posterior Vertebral Column Resection for Severe and Rigid Adult Idiopathic Scoliosis: A Minimum 2-Year Follow-up Comparative Study.

Abstract

Retrospective comparative study. To compare the efficacy and safety of one-stage posterior multiple-level asymmetrical Ponte osteotomies (MAPOs) and single-level posterior vertebral column resection (VCR) for severe and rigid adult idiopathic scoliosis (ADIS). The surgical treatment of severe and rigid ADIS is a demanding and difficult challenge due to its complicated characteristics. Spine surgeons have often pursued advanced correction techniques such as VCR for such patients, which reported to present excellent correction outcomes. But this attractive procedure brought the greatest risk to both surgeons and patients. A total of 48 patients who underwent MAPO or VCR and fusion surgery with minimum 2-year follow-up between February 2009 and November 2015 were enrolled. Twenty-six patients were included in MAPO group and 12 patients in VCR group with an average age of 26.65 ± 8.40 and 27.92 ± 7.50 years, respectively. The average follow-up was 30.24 ± 10.55 months. The surgical details and complications were recorded. The radiological parameters and clinical outcome including Oswestry Disability Index and Scoliosis Research Society-22 questionnaire scores were collected and analyzed. The main curve in MAPO and VCR group were corrected from an average of 98.52° ± 16.50° to 44.11° ± 17.72° and 108.91° ± 16.56° to 56.49° ± 18.82° with no significant difference. The postoperative coronal and sagittal parameters of the two groups were all improved and it showed no significant differences between the two groups. The mean operative time and blood loss of VCR group were significantly greater than those of MAPO group. All the clinical scores were significantly improved at final follow-up, with no significant difference. The incidence of complications in MAPO group was 3.85%, which was significantly lower than that of VCR group. The surgical procedure of multiple asymmetrical Ponte osteotomy is a safe, easy-to-operate, and effective technique that can correct scoliosis and restore the sagittal alignment. It can gain similar correction outcome to VCR, offering the advantages of reduced operation time, blood loss, and greatly reduced the complication. 3.