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Biomechanical analysis of Ponte and pedicle subtraction osteotomies for the surgical correction of kyphotic deformities

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Abstract

Purpose

Biomechanical analysis of Ponte (PO) and pedicle subtraction osteotomies (PSO) in kyphotic deformity instrumentation.

Methods

Patient-specific biomechanical model was used to computationally simulate seven hyperkyphotic instrumentation cases with three osteotomy strategies—1-level PSO, 3-level PO, or 6-level PO; forces within the instrumented spine were assessed and results were analyzed through rANOVA tests.

Results

Corrections with multi-level PO were close to those with one-level PSO. In upright position, average implant forces were from 225 to 280 N and rod bending moments were around 10 Nm with no significant difference between the three strategies (p < 0.05). In simulations of 30° flexion, rod bending moments increased by 38, 2, and 8 %, implant forces increased by 28, 23 and 26 % for the 1-level PSO, 3-level PO, and 6-level PO, respectively. Correction per vertebral level was smaller than the maximum correction allowed by PO and PSO.

Conclusions

Multi-level PO allows similar kyphotic correction to 1-level PSO in spinal deformities with mixed indications for PO and PSO. Loads on the instrumentation constructs in PSO were higher than multi-level PO and higher in 6-level PO than 3-level PO. High loads were located more on the osteotomy sites. The rod shape should be adapted to the anticipated spine correction on the osteotomy sites.

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Acknowledgments

This study was financially supported by the Natural Sciences and Engineering Research Council of Canada and a research support from Medtronic.

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Authors and Affiliations

  1. Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada

    Giuditta Salvi, Carl-Eric Aubin, Franck Le Naveaux & Xiaoyu Wang

  2. Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada

    Giuditta Salvi, Carl-Eric Aubin, Franck Le Naveaux, Xiaoyu Wang & Stefan Parent

Authors
  1. Giuditta Salvi
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  2. Carl-Eric Aubin
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  3. Franck Le Naveaux
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  5. Stefan Parent
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Correspondence to Carl-Eric Aubin.

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Salvi, G., Aubin, CE., Le Naveaux, F. et al. Biomechanical analysis of Ponte and pedicle subtraction osteotomies for the surgical correction of kyphotic deformities. Eur Spine J 25, 2452–2460 (2016). https://doi.org/10.1007/s00586-015-4279-1

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  • DOI: https://doi.org/10.1007/s00586-015-4279-1

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