Ponte Osteotomies Research Articles

Clinical and Radiographic Results in Thoracic Hyperkyphosis Surgical Treatment Considering the Optimal Distal Fusion Area.

Introduction: The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of patients who underwent posterior correction and fusion for thoracic hyperkyphosis, with a focus on determining the optimal distal fusion level. Methods: From 2006 to 2012, 26 patients with a median age of 16.8 years (range 14-25), diagnosed with either idiopathic hyperkyphosis or Scheuermann's kyphosis, underwent posterior fusion and Ponte osteotomies at two medical centers. Radiographic evaluations were performed preoperatively, immediately postoperatively, and at the final follow-up and included assessments of fusion extension, Cobb angle, sagittal balance, and the presence of junctional kyphosis or discopathy. Results: The median follow-up period was 12.3 years (range 11-17). Good clinical outcomes were observed in 24 patients, with no cases of hardware failure. The distal fusion area included the first lordotic vertebra in 17 patients, the sagittal stable vertebra in four patients, and both in five patients. Cobb angle correction was maintained at 50% at the final follow-up (p > 0.05). Significant sagittal balance correction was achieved in 87% of patients immediately postoperatively and was maintained at the final follow-up (p > 0.05). Junctional kyphosis occurred in two patients whose fusion area included only the first lordotic vertebra. Conclusions: Including at least the first lordotic vertebra in the fusion area is crucial for preventing junctional kyphosis. Extending the fusion to the stable vertebra can reduce the incidence of distal junctional kyphosis, especially in symptomatic young adult patients, potentially avoiding the need for revision surgery.

Biportal Endoscopic Lumbar Ponte Osteotomy for Kyphosis: A Technical Note

Biportal endoscopic lumbar Ponte osteotomy (BELPO) is an innovative technique for correcting kyphotic deformities. Unlike the original technique, which maintains an intact anterior column, BELPO involves the endoscopic release of the anterior elements in addition to the endoscopic resection of the posterior elements in interbody fusion. BELPO is performed using unilateral biportal endoscopy with the patient in a prone position. First, a small incision is made in the midline over the interspinous gap. Through this gap, a generous portion of the spinous processes and interspinous ligament is removed. Using this incision as both the viewing and working portal, complete facetectomy and partial laminectomy are performed. Posterior compression is then applied to achieve the desired lordosis. Pedicle screws are fixed with cement augmentation. A 71-year-old female patient presented with low back pain and positive sagittal imbalance. She had a rigid posttraumatic kyphosis at L2–3 due to an old compression fracture at L3. After BELPO, the kyphosis at L2–3 improved from 21º to 2º. BELPO is a promising novel method of minimally invasive deformity correction, offering particular advantages for frail, osteoporotic patients.

Is It Enough to Stop Distal Fusion at L3 in Mild to Moderate Lenke 5C Adolescent Idiopathic Scoliosis Patients?

There has been no definitive conclusion on the selection of the lowest instrumented vertebra (LIV) in Lenke 5C adolescent idiopathic scoliosis (AIS) patients. The purpose of this study was to evaluate whether it is enough to stop distal fusion at L3 in mild to moderate Lenke 5C AIS patients with posterior selective lumbar fusion, Ponte osteotomies and segmental direct vertebra rotation and to analyze the risk factors for postoperative complications in patients selecting L3 as the LIV. A retrospective review was conducted on 106 Lenke 5C AIS patients who underwent corrective surgery in our institution from 2010 to 2021, with a minimum 2-year follow-up. The LIV was L3 or L4. According to the LIV, patients were initially divided into Group I (the LIV was L3) and Group II (the LIV was L4). Then, Group I was further divided into a complication group and a non-complication group. Demographics, radiological parameters, postoperative complications, and clinical outcomes were recorded. Univariate analysis and multivariate logistic analysis were used to identify the risk factors for postoperative complications in patients with L3 as the LIV. There were no significant differences in the demographics, radiological parameters, postoperative complications, or clinical outcomes between Group I and Group II (p > 0.05), and the outcomes were satisfactory in both groups. The main postoperative complications were distal adding-on (11 cases), coronal imbalance (16 cases), proximal junctional kyphosis (2 cases), and internal fixation failure (4 cases). Logistic regression analysis revealed that age and postoperative C7-CSVL were independent predictors of postoperative complications when selecting L3 as the LIV. Terminating the distal fusion level at L3 was practical for mild to moderate Lenke 5C AIS patients. For patients selecting L3 as the LIV, younger patients should be cautious, and maintaining postoperative coronal balance is necessary for avoiding postoperative complications.

P291. Similar results with less spinal cord exposure: comparison of in situ osteotomies with traditional ponte osteotomies in AIS

P291. Similar results with less spinal cord exposure: comparison of in situ osteotomies with traditional ponte osteotomies in AIS

Surgical Treatment Strategies for Severe and Neglected Spinal Deformities in Children and Adolescents without the Use of Radical Three-Column Osteotomies.

Background: Severe spinal deformity manifests as a pronounced deviation from the normal curvature of the spine in the frontal, sagittal, and horizontal planes, where the coronal plane curvature exceeds 90 degrees and may coincide with hyperkyphotic deformity. The most severe deformities exhibit rigidity, with flexibility below 30%. If left untreated or improperly treated, these deformities can result in serious complications associated with progression of the curvature. A combination of surgical techniques is frequently employed to attain optimal outcomes and minimize the risk of complications. The overall medical condition of the patient, their capacity to endure extensive procedures, the expertise of the surgeon, and the resources available all play significant roles in determining the course of management. A systematic and thorough review of the relevant literature was conducted utilizing a variety of electronic databases. The primary objective of this study was to scrutinize the surgical techniques commonly employed in complex spine surgeries for the management of severe scoliosis without resection vertebral body techniques, with higher potential risk of major complications, including permanent neurological deficit. Conclusions: Halo-gravity traction, halo femoral traction, and all techniques for releases of the spine (anterior, posterior, or combine), as well as thoracoplasty, have demonstrated significant effectiveness in managing severe and rigid idiopathic scoliosis. The combination of several of these methods can lead to optimal alignment correction without the need to perform high-risk techniques involving three-column osteotomies. Surgeons must customize the indications based on factors such as available resources, characteristics of the deformity, and the patient's individual profile. Surgical correction of severe scoliosis without vertebral body resection surgeries decreases the potential risks related to neurological and pulmonary complications while providing significant clinical improvement outcomes. The powerful Ponte osteotomy is indicated for severe scoliosis, curves with poor flexibility, for better restoration of hypokyphosis, and decrease of hyperkyphosis. These corrective techniques combined with HGT or temporary internal distraction rods are recommended as viable options for managing individuals with severe rigid spine deformity characteristics. Therefore, they also should be considered and performed by a proficient surgical team. The presence of neuromonitoring is crucial throughout these procedures.

Posterior Spinal Fusion for Severe Kyphosis in a Child with Gaucher Disease: A Case Report and Review of the Literature

Background: Skeleton involvement is one of the most significant aspects of Gaucher disease (GD). However, the treatment for spinal involvement in GD among patients undergoing enzyme replacement therapy (ERT) is poorly characterized. We present a case of progressive kyphotic spinal deformity in a young child caused by vertebral involvement, which was managed by posterior spinal fusion without anterior spinal release under ERT. Case presentation: This is a retrospective study. A 10-year-old boy presenting with progression kyphosis (thoracic kyphotic angle of 113°) associated with type-IIIb GD had undergone posterior spinal fusion with segmental pedicle screw fixation (from T6-L3) and Ponte osteotomy. The patient went back to school without further brace protection. Proximal junctional kyphosis (PJK) was observed at 4 months postoperatively. Revision surgery was performed to prevent neurological impairment. Additional posterior spinal fusion from T2–T6 and decompressive laminectomy were performed during the revision surgery. A 2-year follow-up showed no recurrence of PJK and solid fusion was achieved in the patient under ERT and brace protection. Conclusions: Posterior spinal fusion without anterior spinal release is a good treatment option for severe spinal deformity in patients with GD. However, the fusion level and reinforced fixation require careful consideration. Revision surgery and brace protection is needed as long as PJK is observed.

The effectiveness of a low implant density in Scheurmann kyphosis in correcting the lumbar lordosis -pelvic incidence mismatch

Purpose To evaluate the effectiveness of using a low implant density in surgical treatment of Scheurmann Kyphosis (SK) in correcting the lumbar lordosis (LL)- Pelvic incidence (PI) mismatch. Methods Patients that were surgically treated for SK by a low screw density with multiple Ponte osteotomies at two institutions from January 2021 to January 2022 were identified and included in the study. Preoperative/postoperative/1- and 2-year follow-up measurements were analyzed from full-spine standing radiographs. Results Thirty patients were enrolled in our study, mean age 20.5 (13–37) years, mean preoperative kyphosis was 85.9 (75–108), a mean preoperative lumbar lordosis-pelvic LL-PI mismatch was 25.9 (23–28). The maximum kyphosis was corrected to 46.2 (37–63) and the LL-PI mismatch was reduced to 7.7. The correction was maintained at 1- and 2-years follow-up with no statistical change in the sagittal angles. Conclusion Surgical correction of SK using low-density implants and multiple Ponte osteotomies is an effective method of correcting the kyphotic deformity and reducing the LL-PI mismatch to normal physiological values.

Surgical treatment of scoliosis in patients with osteogenesis imperfecta: a single institution case series.

Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by skeletal deformities, bone fragility, and spinal complications. Various studies' insights underscored the impact of scoliosis on pulmonary function, positive outcomes with spinal fusion, and improved functional abilities post-surgery. However, partial loss of correction remains inevitable. This study examines six surgically treated OI patients with scoliosis. Surgical intervention using a posterior approach with pedicle screws and hooks aimed to correct spinal deformities. Preoperative, postoperative, and follow-up radiological assessments were conducted, revealing significant reductions in scoliotic angles post-surgery. Complications included infections and proximal junctional kyphosis requiring revision surgeries. Despite the challenges posed by poor bone quality and implant stability, no implant failures occurred in this series. Ponte osteotomies at the apex of deformity aided in corrective maneuvers. Surgical treatment of scoliosis in patients affected by OI is challenging and may be associated with perioperative and postoperative complications. Ponte osteotomy may improve the correction and reduce necessary force at the time of correction.

Comparing Relative Value Units for Intramedullary Limb Lengthening Procedures to Common Pediatric Orthopaedic Surgeries to Determine Adequate Compensation.

Reimbursement for surgical procedures is determined by a computation of the relative value unit (RVU) associated with CPT codes. It is based on the amount of work required to provide a service, resources available, and level of expertise involved. Given the evolution of changes in the limb lengthening field, we wanted to evaluate whether the RVU values were comparable across different orthopaedic subspecialties. Consequently, this study compares the work relative value unit (wRVU) totals of 3 common pediatric orthopaedic surgeries-arthroscopic ACL reconstruction, spinal fusion for adolescent idiopathic scoliosis, and antegrade femoral intramedullary limb lengthening. This was an IRB-approved, multicenter, retrospective chart review. Charts of subjects who had ACL reconstructions, including meniscal repairs; spinal fusion surgeries for adolescent idiopathic scoliosis (7 to 12 levels), including Ponte osteotomies, and femoral antegrade internal limb lengthening procedures, each completed by fellowship-trained orthopaedic surgeons were reviewed. Comparisons were carried out between several parameters, including mean duration per procedure, number of CPT codes billed per procedure, number of postoperative visits in the 90-day global period, and the wRVU for each procedure. Fifty charts (25 per center) per procedure were reviewed. The wRVU per hour was lowest in the antegrade femur lengthening group ( P < 0.0001). The number of postoperative visits in the 90-day global postsurgery period was significantly higher in the antegrade femur lengthening group ( P < 0.0001). Intramedullary limb lengthening also had the least number of CPT codes billed. RVUs per time are statistically lowest in the limb lengthening group and highest in the scoliosis group. The limb lengthening patient also requires significantly more visits and time in the postoperative period compared with the other groups. These extra visits during the global period do not add any RVU value to the lengthening surgeon and occupy clinic spots that could be filled with new patients. Based on these data, a review of the RVU values assigned to the limb lengthening codes may be necessary. Level III-retrospective comparison study.

The Surgical Management of Severe Scoliosis in Immature Patient with a Very Rare Disease Costello Syndrome-Clinical Example and Brief Literature Review.

Costello syndrome (CS) is a rare genetic syndrome in which, due to the occurrence of a mutation in the HRAS gene on chromosome 11 that causes the manifestation, a set of features such as a characteristic appearance, many congenital defects, intellectual disability and a genetic predisposition to cancer, friendly personality, and others can be identified. CS is very rare, with an incidence of ~1/300,000, but it belongs to one of the largest groups of congenital syndromes, called RASopathies, occurring with an incidence of 1/1000 people. Scoliosis and kyphosis, as well as other spinal defects, are common, in 63% and 58% of patients, respectively, and a study conducted among adult patients showed the presence of scoliosis in 75% of patients; there may be excessive lordosis of the lumbar section and inverted curvatures of the spine (lordosis in the thoracic section and kyphosis in the lumbar section). The aim of our study is to present a case report of treatment of severe scoliosis of 130 degrees in a 14-year-old patient with Costello syndrome, with coexisting Chiari II syndrome and syrinx in the absence of skeletal maturity. This patient underwent foramen magnum decompression 3 months before planned surgical correction for severe scoliosis. The patient was qualified for surgical treatment using magnetically controlled growing rods (MCGR). After spine surgery using MCGR, we gradually performed MCGR distraction over the next 2 years; we performed the final surgery, conversion to posterior spinal fusion (PSF) with simultaneous multi-level Ponte osteotomy, which gave a very good and satisfactory surgical result. In the perioperative period, two serious complications occurred: pneumothorax caused by central catheter and gastrointestinal bleeding due to previously undiagnosed gastrointestinal varices. This case shows that the treatment of severe and neglected scoliosis is complicated and requires special preparation and a surgical plan with other cooperating specialists. The scoliosis was corrected from 130 degrees to approximately 48 degrees, sagittal balance was significantly improved, and the surgical outcome was very pleasing, significantly improving quality of life and function for the patient.

Ponte osteotomies for treatment of spinal deformities: they are not all made equal.

To compare surgical outcomes of Ponte's osteotomies for treatment of adolescent idiopathic scoliosis (AIS), Scheuermann's kyphosis (SK), and adult scoliosis (AdS). We conducted a retrospective review of patients with AIS, SK, and AdIS who underwent posterior spinal instrumented fusion (PSIF) at our Institution from January 2019 to December 2022. Demographics, imaging, and intraoperative data (including number of osteotomies performed, blood losses, surgical timing, and complications) were extracted from patient charts. A total of 80 patients (62 AIS, 7 SK, and 11 AdS) were enrolled in the study. All patients were treated with a PSIF and a total of 506 Ponte osteotomies were performed (5.8 ± 4.1, 9.3 ± 2.4, and 7.5 ± 2.5 average osteotomies per patient in the AIS, SK, and AdS group, respectively; p = 0.045). Average time per osteotomy was 6.3 ± 1.5min in the AIS group, and 5.8 ± 2.1 and 8.7 ± 4.0 in the SK and AdS group, respectively (p = 0.002). Blood loss was significantly smaller in the SK group (8.6 ± 9.6ml per osteotomy) compared to AIS group (34.9 ± 23.7ml) and AdS group (34.9 ± 32.7ml) (p = 0.001). A total of 4 complications were observed in the AIS group (1.1%) and 2 complications in the AdS group (2.4%), but this was not statistically significant. Our study shows that Ponte's osteotomies are safe and effective in surgical treatment of AIS, SK, and AdS. Blood loss and execution time per osteotomy are significantly smaller in the SK group compared to AIS and AdS. No significant differences were noted in terms of complications between the three groups.

Clinical outcome of posterior lumbar interbody fusion combined with Ponte osteotomy for reconstruction of coronal sagittal plane balance in degenerative scoliosis

Objective: To evaluate the clinical efficacy of posterior lumbar interbody fusion combined with Ponte osteotomy in the treatment of patients with degenerative scoliosis. Methods: The medical records and imaging data of degenerative scoliosis in department of orthopedics, Peking Union Medical College Hospital from 2013 to 2022 were retrospectively collected, and the shortest follow-up time was 1 year. A total of 38 patients were included, including 13 males and 25 females, aged 50-87(65.6±10.9) years old.The follow-up was12-119(43±20) months. Standing position full spine anteroposterior lateral X-ray examinations were performed on all patients preoperatively, postoperatively, and at latest follow-up. The length of hospital stay, complications, operation time, blood loss, instrumented segment, fusion segmen were recorded. The clinical scores and coronasagittal imaging indicators at three time points were compared. Results: The operation time was (274.5±70.5)min, and intraoperative blood loss was (619.2±93.5)ml. The coronal vertical axis was improved from (2.9±1.8)cm preoperatively to (1.2±1.0)cm postoperatively. The preoperative coronal Cobb angle was 16.6°±9.9° and the immediate postoperative correction was 6.4°±4.0°(t=-6.83, P<0.001). The difference was statistically significant (t=-6.12, P<0.001). The coronal Cobb Angle at the last follow-up was 5.7°±3.7°, and there was no significant orthopaedic loss at the last follow-up (t=-6.12, P<0.001).The sagittal vertical axis decreased from (5.6±3.9)cm preoperatively to (3.2±2.5) cm immediately after operation (t=-6.83,P<0.001), and was well maintained at the last follow-up[(2.7±1.8) cm,t=-7.77,P<0.001]. Lumbar lordosis increased from 21.8°±10.2° preoperatively to 35.8°±8.3° postoperatively(t=12.01, P<0.001)and 40.1°±8.6° at last follow-up(t=-10.21, P<0.001). Oswestry disability score (ODI score), visual analogue score (VAS) low back pain score and VAS leg pain score were also lower after surgery than before surgery (all P<0.05). Conclusion: Posterior lumbar interbody fusion combined with Ponte osteotomy can significantly improve the coronal and sagittal plane deformity and postoperative functional score in adult patients with degenerative scoliosis.

Treatment of an anterior cervicothoracic myelomeningocele together with spine deformity correction in a child: illustrative case.

Anterior cervicothoracic myelomeningoceles are a rare pathology. In reported cases, treatment has included shunting, isolated resection and repair without deformity correction, or isolated deformity correction without meningocele repair. The authors describe a pediatric patient with an anterior cervicothoracic myelomeningocele presenting with progressive neurological decline, who underwent simultaneous treatment of the myelomeningocele to detether the spinal cord and achieve major correction of the scoliotic deformity. A 15-year-old girl was born with C7-T1-T2 hemivertebrae and anterior cervical myelomeningocele at C7-T1. She developed progressive cervical thoracic scoliosis, left hemiparesis initially, and additional right hemiparesis eventually. She underwent surgical repair via C7, T1, and T2 corpectomies with intradural detethering of the spinal cord. The scoliosis was treated with C7-T2 Ponte osteotomies and C2-T5 posterior fixation, followed by anterior reconstruction with a titanium cage and anterior plate from C6 to T3. The myelomeningocele was adequately treated with good correction of the patient's deformity. The patient had postoperative improvement in her strength and solid arthrodesis on postoperative imaging. The authors describe the successful treatment of an anterior cervicothoracic myelomeningocele and associated scoliosis in a child. This is a unique report of a combined strategy to achieve both deformity correction and detethering of the spinal cord.

Effectiveness of a two-stage posterior-anterior–posterior surgery using subcutaneously preserved autologous bone grafts for adult spinal deformity: a retrospective observational study

BackgroundTo achieve optimal correction of rigid kyphoscoliosis, we developed a novel two-stage posterior-anterior–posterior (PAP) surgery using subcutaneously preserved autologous bone grafts. This study aimed to investigate the effectiveness of two-stage PAP surgery versus single-stage anterior–posterior (AP) surgery.MethodsThis was a retrospective analysis of patients undergoing combined anterior–posterior long-level fusion for adult spinal deformity (ASD) with a minimum 2-year follow-up. The indications for two-stage PAP surgery were rigid thoracolumbar deformity associated with hypertrophic facet arthritis and/or a large pelvic incidence–lumbar lordosis mismatch of > 25°. In the first stage of PAP surgery, pedicle screw insertion and multilevel Ponte osteotomies were performed. The resected local bone was embedded under sutured fascia. One week later, the embedded bone was retrieved in the right lateral position and used as an autograft for lateral lumbar interbody fusion. Final deformity correction was performed in the prone position.ResultsFrom January 2018 to April 2021, 12 and 16 patients with ASD underwent two-stage PAP surgery (PAP group) and single-stage AP surgery (AP group), respectively. Although PAP surgery was associated with a significantly longer operation time, the total blood loss volume was significantly less in the PAP group than the AP group. Compared with the AP group, the PAP group showed significantly larger postoperative changes in radiological parameters in the sagittal and coronal planes. The overall complication rate did not differ significantly between the two groups.ConclusionTwo-stage PAP surgery provided effective correction of rigid kyphoscoliosis without increasing blood loss and postoperative complication rates.

Ponte Osteotomies in the Surgical Treatment of Adolescent Idiopathic Scoliosis: A Systematic Review of the Literature and Meta-Analysis of Comparative Studies.

The purpose of the present paper is to assess if Ponte osteotomies (POs) allow for a better correction in adolescent idiopathic scoliosis (AIS) surgery and to investigate their safety profile. A systematic search of electronic databases was conducted. Inclusion criteria: comparative studies that reported the outcomes of AIS patients who underwent surgical correction through posterior-only approach with and without POs. Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed to estimate the differences between patients treated with and without POs. p < 0.05 was considered significant. In total, 9 studies were included. No significant difference in thoracic kyphosis (TK) change between patients treated with and without POs was found (+3.8°; p = 0.06). Considering only hypokyphotic patients, a significant difference in TK change resulted in POs patients (+6.6°; p < 0.01), while a non-significant TK change resulted in normokyphotic patients (+0.2°; p = 0.96). No significant difference in coronal correction (2.5°; p = 0.10) was recorded. Significant estimated blood loss (EBL) (142.5 mL; p = 0.04) and surgical time (21.5 min; p = 0.04) differences were found with POs. Regarding complications rate, the meta-analysis showed a non-significant log odds ratio of 1.1 (p = 0.08) with POs. In conclusion, POs allow for the restoration of TK in hypokyphotic AIS, without a significantly greater TK change in normokyphotic patients, nor a significantly better coronal correction. Considering the significantly greater EBL and the trend toward a higher complications rate, the correct indication for POs is crucial.

Experience in Managing Posttraumatic Lumbar Kyphosis Patients with Multi-level Ponte Osteotomies and Posterior Spinal Fusion

Posttraumatic kyphosis (PTK) is a spinal deformity resulting from severe trauma, posing significant challenges for surgical correction. PTK can lead to chronic pain and disability, necessitating careful evaluation and individualized treatment strategies. We present the case of a 50-year-old male with a decade-long history of PTK following a traumatic fall from a truck. Despite initial mobility, his condition worsened, affecting his posture and causing pain. Radiographic assessments revealed marked lumbar lordosis (LL) loss, positive sagittal vertebral axis, and pelvic parameters mismatch. Surgical planning involved multilevel Ponte osteotomy from L1 to L4 and posterior spinal fusion from Th10 to S1 to restore sagittal balance. Treating PTK is complex and technically demanding, with no universal approach due to the diversity of cases. Detailed diagnostics, including spinal alignment analysis and neurologic assessments, guide surgical decisions. Our patient’s successful treatment employed grade 1/2 Ponte osteotomies for lumbar correction, achieving improved sagittal balance and LL. However, an increase in pelvic incidence (PI) and persistent PI-LL mismatch was noted postsurgery, suggesting potential effects on the sacroiliac joint. Severe trauma can lead to PTK, necessitating meticulous evaluation and individualized surgical strategies. The primary goal is to alleviate neurological deficits and restore sagittal balance, with surgical choices tailored to each patient’s unique circumstances. Surgical correction may influence pelvic parameters, emphasizing the importance of comprehensive postoperative assessment and follow-up care.

Outcomes of Ponte osteotomy combined with posterior lumbar interbody fusion for reconstruction of coronal and sagittal balance in degenerative scoliosis

PurposeThe purpose of the study was to evaluate the clinical efficacy and safety of using Ponte osteotomy combined with posterior lumbar interbody fusion in the treatment of patients with degenerative scoliosis.MethodThe medical records and imaging data of degenerative scoliosis patients in our department from 2013 to 2022 were retrospectively collected. A total of 47 patients were included, including 16 male patients and 31 female patients. The mean follow-up was 47.8 months. Whole spine X-rays in the standing position were performed on all patients preoperatively, postoperatively, and at the latest follow-up. The length of hospital stay, complications, operative duration, estimated blood loss, instrumented segment, fused segment, clinical scores, and various radiological indicators were recorded.ResultsThe coronal vertical axis improved from 3.1 ± 1.9 cm preoperatively to 1.2 ± 1.0 cm postoperatively with an average reduction of 1.9 ± 1.7 cm. The preoperative coronal Cobb angle was 18.1 ± 10.6°, the immediate postoperative Cobb angle was 6.6 ± 3.9°, and the Cobb angle at the last follow-up was 5.8 ± 3.7°. The sagittal vertical axis decreased from 5.6 ± 3.7 cm preoperatively to 2.7 ± 1.9 cm immediately after the operation and was well maintained at the last follow-up (3.1 ± 2.5 cm). Lumbar lordosis increased from 22.2 ± 10.2° preoperatively to 40.4 ± 8.3° postoperatively and 36.0 ± 8.8° at the last follow-up. The ODI score, VAS low back pain score, and VAS leg pain score were also improved to varying degrees.ConclusionPonte osteotomy combined with posterior lumbar interbody fusion can significantly improve coronal and sagittal plane deformities and postoperative functional scores in patients with adult degenerative scoliosis.

Long-term outcome evaluation in ankylosing spondylitis with high-angle thoracolumbar kyphotic deformity corrected by one-stage single-level pedicle subtraction osteotomy augmented with Ponte osteotomy: A case series

Introduction and importanceA high-angle thoracolumbar kyphotic deformity (TLKD) may complicate surgical rectification of AS patients since one-stage two-level pedicle subtraction osteotomy (PSO), which provides high-angular correction, leads to excessive blood loss, neurological deficits and fixation failures. This case series presents the long-term results of one-stage single level PSO with Ponte osteotomy (PO) in the treatment of AS patients with high-angle TLKD. Case presentationThis case series presents two AS patients with high kyphotic angles (KAs) of 86.1o. We collected data retrospectively from our institution's database between 2019 and 2023. A sagittal axis imbalance was the only complaint initially, no neurological deficits or other problems. A PSO augmented by PO was performed with a decompression laminectomy. Intraoperative monitoring (IOM) during reduction was used to observe neurological deficits. Blood loss at the highest rate was 1000 cc. It corrected 57.8o of KA postoperatively without neurological deficits. We found consistent results over 36 months. Clinical discussionA thorough analytical approach may help diagnose AS. One-stage single-level PSO may correct high-angle TLKD in AS patients effectively. To achieve greater angular correction, PO, a less risky osteotomy, must be added. Decompression laminectomy is vital before osteotomy and IOM is crucial during reduction to prevent nerve injury. Even with two osteotomies, there was less blood loss than previously reported. These impressive long-term results call for further research. ConclusionCombined PSO and PO with IOM efficiently magnifies the angular correction without postoperative neurological deficits or excessive blood loss in AS patients with high-angle TLKD.

Intraoperative Radiation Exposure in Adolescent Idiopathic and Neuromuscular Scoliosis.

Intraoperative imaging is often used to aid pedicle screw placement during scoliosis operations. Higher rates of cancer and death have been observed in orthopaedic surgeons and radiation technologists, including a fourfold higher rate of breast cancer in female orthopaedic surgeons. The purpose of this study was to evaluate variability in intraoperative radiation during spinal fusions for both adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis (NMS). A retrospective review of posterior spinal fusion and segmental spinal instrumentation for scoliosis performed by pediatric orthopaedic surgeons from 2017 to 2019 at a single institution was performed. Inclusion criteria included: a diagnosis of AIS or NMS and patients between 8 and 18 years of age. Exclusion criteria included: revision surgery, use of intraoperative navigation, and patients younger than 10 at the time of scoliosis onset within the AIS cohort. Data collected included: preoperative curve, body mass index (BMI), number of levels fused, number of Ponte osteotomies, and fluoroscopy time. One-way analysis of variance tests, Bonferroni post hoc tests, independent t tests, and Pearson correlations were utilized with significance determined at the 95% confidence level (a = 0.05). A total of 148 patients were included in the study. The average fluoroscopy time was 143 ± 67 seconds. Patients with NMS had higher average fluoroscopy times (193 ± 75 s) compared with patients with AIS (129 ± 58 s, P < 0.001). In patients with AIS, fluoroscopy time correlated to the patient's preoperative curve (r = 0.182, P = 0.050). Patients with AIS with fewer than 12 levels fused had significantly less radiation exposure than those with 12 or more levels fused (P = 0.01). When controlling for the number of levels fused, patients with AIS with higher BMIs had significantly greater fluoroscopy times (P = 0.001). In patients with NMS, fluoroscopy time negatively correlated with BMI (r = -0.459, P = 0.009) and positively correlated with a preoperative curve (r = 0.475, P = 0.007). Fluoroscopy times vary greatly during adolescent spinal fusions for scoliosis. Longer fluoroscopy times are correlated with: NMS diagnosis, larger preoperative curve, BMI, and number of levels fused. Surgeons' knowledge of factors affecting fluoroscopy time will increase awareness and may be the first step in decreasing intraoperative radiation risks. Level III; Therapeutic-a retrospective study.

Correction of severe adult idiopathic scoliosis posteriorly with skipped pedicle screw instrumentation and rod augmentation.

Although it is challenging to correct severe adult idiopathic scoliosis (ADIS) deformities, optimal results can be achieved by multiple asymmetric Ponte osteotomies with lower surgical risks. Skipping the apical instrumentation and using multiple rods and connectors may further facilitate the procedure. We named this method as "modular correction technique" (MCT). Sixty-two patients with severe ADIS who were treated with MCT were recruited into this study, and retrospectively evaluated. Radiographic and functional outcomes as well as pulmonary functions were examined preoperatively and at last follow-up. Main radiologic parameters were related to Cobb angles, coronal, sagittal, and shoulder balance. Scoliosis Research Society-22 questionnaire and the Oswestry Disability Index were used to evaluate clinical outcomes. Average age of the patients was 41.3 years (range: 23-65). Thirty-nine of the patients were female and 23 of them were male. Coronal Cobb angle of the main curve, shoulder balance, coronal, and sagittal balance significantly improved after the surgery. Forced vital capacity and forced expiratory volume in the first second were mildly improved after the surgery, however the improvement was not statistically significant. Postoperative clinical outcome scores improved significantly. MCT can be performed with low risk of complications and relatively low operation time and blood loss. It facilitates rod insertion and correction maneuvers. Radiologic, especially coronal balance, and functional outcomes can be improved with minimal morbidity while deterioration of pulmonary function is prevented. This technique is useful in severe but relatively flexible ADIS deformities.