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Quantification of Increase in Three-dimensional Spine Flexibility Following Sequential Ponte Osteotomies in a Cadaveric Model

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Abstract

Background

Posterior-only procedures are becoming more popular for treatment of rigid adolescent idiopathic scoliosis, but little is known about the quantitative correction potential for Ponte osteotomies. The objective of this study was to quantify and compare the range of motion of intact multilevel thoracic spine segments with the same segments after each of 3 sequential Ponte osteotomies.

Methods

We tested 5 human cadaveric thoracic spine segments, spanning T—T6, or 11—112, in an 8-degree-of-freedom servo-hydraulic load frame, monitoring motion of each vertebra with an optical motion tracker. We measured range of motion while we applied cyclic, pure moment loading to produce flexion-extension, lateral bending, and axial rotation at a rate of 0.5°/second, to a maximum of ± 6 Nm. Each specimen was tested intact and after each of 3 sequential Ponte osteotomies.

Results

Total range of motion for the segments (either T2—T5 or T8—Til) increased by as much as 1.6° in flexion, 1.5° in extension, 0.5° in lateral bending, and 2.8° in axial rotation with each osteotomy. Because of the variation in initial specimen stiffness, we normalized motions to the intact values. In flexion, average range of motion increased after each osteotomy compared with intact, by 33%, 56%, and 69%. In extension, slightly smaller increases were seen, increasing by as much as 56% after the third osteotomy. In lateral bending, Ponte osteotomies had little effect on range of motion. In axial rotation, range of motion increased by 16%, 29%, and 65% after 3 osteotomies.

Conclusions

Sequential Ponte osteotomies increased range of motion in flexion, extension, and axial rotation, but not in lateral bending. These results suggest that the Ponte osteotomy may be appropriate when using derotational correction maneuvers, or to improve apical lordosis at the apex of curvature during posterior spinal fusion procedures. Although these techniques are effective in gaining correction for kyphotic deformities and rigid curvatures, they add time and blood loss to the procedure.

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References

  1. Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis 2006;1:2.

    Article  Google Scholar 

  2. Howden LM, Meyer JA. Age and sex composition: 2010. 2010 Census Briefs 2011. Available at: http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf. Accessed January 30, 2013.

  3. Geek MJ, Macagno A, Ponte A, Shufflebarger HL. The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech 2007;20:586–93.

    Article  Google Scholar 

  4. Diab MG, Franzone JM, Vitale MG. The role of posterior spinal osteotomies in pediatric spinal deformity surgery: indications and operative technique. J Pediatr Orthop 2011;31(1 Suppl):S88–98.

    Article  Google Scholar 

  5. Kim YJ, Lenke LG, Kim J, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2006;31:291–8.

    Article  Google Scholar 

  6. Suk SI, Kim WJ, Lee SM, et al. Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine (Phila Pa 1976) 2001;26:2049–57.

    Article  CAS  Google Scholar 

  7. Suk SI, Lee CK, Kim WJ, et al. Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine (Phila Pa 1976) 1995;20:1399–405.

    Article  CAS  Google Scholar 

  8. Lehman Jr RA, Lenke LG, Keler KA, et al. Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs: minimum three-year follow-up of one hundred fourteen cases. Spine (Phila Pa 1976) 2008;33:1598–604.

    Article  Google Scholar 

  9. Ponte A, Vero B, Siccardi G. Surgical treatment of Scheuermann’s hyperkyphosis. In: Winter R, editor. Progress in Spinal Pathology: Kyphosis. Bologna, Italy: Aulo Gaggi; 1984. p. 75–80.

    Google Scholar 

  10. Ponte A. Posterior column shortening for Scheuermann’s kyphosis. In: Haher T, Merola A, editors. Surgical Techniques for the Spine. New York: Thieme Verlag; 2003. p. 107–13.

    Google Scholar 

  11. Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg Am 1945;27:1–11.

    Google Scholar 

  12. Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine 2005;30:2030–7. discussion 2038.

    Article  Google Scholar 

  13. White III AA, Hirsch C. The significance of the vertebral posterior elements in the mechanics of the thoracic spine. Clin Orthop Relat Res 1971;81:2–14.

    Article  Google Scholar 

  14. Panjabi MM, Hausfeld JN, White III AA. A biomechanical study of the ligamentous stability of the thoracic spine in man. Acta Orthop Scand 1981;52:315–26.

    Article  CAS  Google Scholar 

  15. Takeuchi T, Abumi K, Shono Y, et al. Biomechanical role of the intervertebral disc and costovertebral joint in stability of the thoracic spine: a canine model study. Spine 1999;24:1414–20.

    Article  CAS  Google Scholar 

  16. Watkins IV R, Watkins III R, Williams L, et al. Stability provided by the sternum and rib cage in the thoracic spine. Spine 2005;30:1283–6.

    Article  Google Scholar 

  17. Yoganandan N, Maiman DJ, Pintar FA, et al. Biomechanical effects of laminectomy on thoracic spine stability. Neurosurgery 1993;32:604–10.

    Article  CAS  Google Scholar 

  18. Oda I, Abumi K, Lii, et al. Biomechanical role of the posterior elements, costovertebral joints, and rib cage in the stability of the thoracic spine. Spine 1996;21:1423–9.

    Article  CAS  Google Scholar 

  19. Oda I, Abumi K, Cunningham BW, et al. An in vitro human cadaveric study investigating the biomechanical properties of the thoracic spine. Spine 2002;27:E64–70.

    Article  Google Scholar 

  20. Horton WC, Kraiwattanapong C, Akamaru T, et al. The role of the sternum, costosternal articulations, intervertebral disc, and facets in thoracic sagittal plane biomechanics: a comparison of three different sequences of surgical release. Spine 2005;30:2014–23.

    Article  Google Scholar 

  21. Feiertag MA, Horton WC, Norman JT, et al. The effect of different surgical releases on thoracic spinal motion: a cadaveric study. Spine 1995;20:1604–11.

    Article  CAS  Google Scholar 

  22. Anderson AL, McIff TE, Asher MA, et al. The effect of posterior thoracic spine anatomical structures on motion segment flexion stiffness. Spine 2009;34:441–6.

    Article  Google Scholar 

  23. Wilke HJ, Jungkunz B, Wenger K, et al. Spinal segment range of motion as a function of in vitro test conditions: effects of exposure period, accumulated cycles, angular-deformation rate, and moisture condition. Anat Rec 1998;251:15–9.

    Article  CAS  Google Scholar 

  24. Panjabi MM, Kraq M, Summers D, Videman T. Biomechanical time-tolerance of fresh cadaveric human spine specimens. J Orthop Res 1985;3:292–300.

    Article  CAS  Google Scholar 

  25. Sangiorgio SN, Sheikh H, Borkowski SL, et al. Comparison of three posterior dynamic stabilization devices. Spine (Phila Pa 1976) 2011;36:E1251–8.

    Article  Google Scholar 

  26. Wilke HJ, Wenger K, Claes L. Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J 1998;7:148–54.

    Article  CAS  Google Scholar 

  27. Crawford NR, Dickman CA. Construction of local vertebral coordinate systems using a digitizing probe: technical note. Spine (Phila Pa 1976) 1997;22:559–63.

    Article  CAS  Google Scholar 

  28. White AA, Panjabi MM. Clinical Biomechanics of the Spine. 1st ed. Philadelphia: JB Lippincott; 1978.

    Google Scholar 

  29. Lee SM, Suk SI, Chung ER. Direct vertebral rotation: A new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2004;29:343–9.

    Article  Google Scholar 

  30. Ashman RB, Birch JG, Bone LB, et al. Mechanical testing of spinal instrumentation. Clin Orthop Relat Res 1988;227:113–25.

    CAS  PubMed  Google Scholar 

  31. Ashman RB, bechtold J, Edwads WT, et al. In vitro spinal arthrodesis implant mechanical testing protocols. J Spinal Disord 1989;2:274–81.

    Article  CAS  Google Scholar 

  32. Wiemann J, Durrani S, Bosch P. The effect of posterior spinal releases on axial correction torque: a cadaver study. J Child Orthop 2011;5:109–13.

    Article  Google Scholar 

  33. Cheng I, Hay D, Iezza A, et al. Biomechanical analysis of derotation of the thoracic spine using pedicle screws. Spine (Phila Pa 1976) 2010;35:1039–43.

    Article  Google Scholar 

  34. Busscher I, va der Veen AJ, van Dieen JH, et al. In vitro biomechanical characteristics of the spine: a comparison between human and porcine spinal segments. Spine (Phila Pa 1976) 2010;35:E35–42.

    Article  Google Scholar 

  35. Halanski MA, Cassidy JA. Do multilevel Ponte osteotomies in thoracic idiopathic scoliosis surgery improve curve correction and restore thoracic kyphosis? J Spinal Disord Tech In press (2011 Epub ahead of print).

    Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Biomechanics and Mechanobiology Lab, Santa Monica UCLA Medical Center and Orthopaedic Hospital, 1250 Sixteenth St, Suite 2260, Santa Monica, CA, 90404, USA

    Sophia N. Sangiorgio PhD, Sean L. Borkowski MS, Nathan L. Frost MD & Edward Ebramzadeh PhD

  2. UCLA Bioengineering/Biomedical Engineering IDP, University of California Los Angeles, 5121 Engineering V, Los Angeles, CA, 90095, USA

    Sean L. Borkowski MS

  3. Los Angeles Orthopaedic Hospital and UCLA Department of Orthopaedic Surgery, 1250 Sixteenth St, Santa Monica, CA, 90404, USA

    Richard E. Bowen MD, Anthony A. Scaduto MD & Nathan L. Frost MD

Authors
  1. Sophia N. Sangiorgio PhD
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  2. Sean L. Borkowski MS
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  3. Richard E. Bowen MD
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  4. Anthony A. Scaduto MD
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  5. Nathan L. Frost MD
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  6. Edward Ebramzadeh PhD
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Correspondence to Sophia N. Sangiorgio PhD.

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Sangiorgio, S.N., Borkowski, S.L., Bowen, R.E. et al. Quantification of Increase in Three-dimensional Spine Flexibility Following Sequential Ponte Osteotomies in a Cadaveric Model. Spine Deform 1, 171–178 (2013). https://doi.org/10.1016/j.jspd.2013.01.006

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  • DOI: https://doi.org/10.1016/j.jspd.2013.01.006

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