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Ponte Osteotomies With Pedicle Screw Instrumentation in the Treatment of Adolescent Idiopathic Scoliosis

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Abstract

Study design

Review of prospective database.

Objectives

To report the results of Ponte osteotomy with pedicle screw instrumentation for major thoracic adolescent idiopathic (AIS) curves. p ]Summary of background data: Ponte osteotomy for achieving coronal and sagittal correction of major thoracic curves in AIS with pedicle screw instrumentation is a widespread technique, but results have not been well described.

Methods

Review of 87 consecutive AIS patients with Lenke 1—4 curves who underwent Ponte osteotomies and pedicle screw instrumentation by 2 surgeons at a single institution. Surgical details, blood loss, and complications were recorded. We evaluated coronal and sagittal radiological measurements and Scoliosis Research Society-22 (SRS-22) questionnaire scores over 2-year follow-up. p ]Results: The mean preoperative thoracic coronal Cobb angle was 57° ± 9.7°, fulcrum flexibility was 47.2%, and lateral Cobb angle was 17.8° ± 4°. The mean estimated blood loss (EBL), expressed as percent estimated blood volume, was 35.8 ± 20.5 mL. There was significant improvement in coronal thoracic Cobb angle, percent correction, and apical vertebral translation over 2-year follow-up (p <.05). In hypokyphotic curves, there was a significant increase in lateral thoracic T5-T12 kyphosis from 8.1° to 18.3° (p <.001). In hyperkyphotic curves, mean lateral thoracic T5—T12 kyphosis improved from 45° to 26° (p <.001). Median SRS-22 domains were higher after treatment (p <.05). Complications included significant hypotension (1), EBL greater than 75% estimated blood volume (2), and wound infection needing drainage (2). There were neuromonitoring signal changes in 7 patients but no significant neurological complications.

Conclusions

In this case series of major thoracic AIS curves treated with segmental pedicle screw instrumentation and Ponte osteotomies, there was an improvement in the coronal and sagittal radiological parameters. A prospective controlled study is needed to determine whether pedicle screw instrumentation and Ponte osteotomies influence outcomes and complications.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Suken A. Shah MD, Arjun A. Dhawale MD, Petya Yorgova MS, Geraldine I. Neiss PhD, Laurens Holmes Jr. PhD, DrPH & Peter G. Gabos MD

  2. Department of Orthopaedic Surgery, Central California Children’s Hospital, 9300 Children’s Blvd, Madera, CA, 93636, USA

    Jon E. Oda MD

Authors
  1. Suken A. Shah MD
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  2. Arjun A. Dhawale MD
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  3. Jon E. Oda MD
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  4. Petya Yorgova MS
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  5. Geraldine I. Neiss PhD
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  6. Laurens Holmes Jr. PhD, DrPH
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  7. Peter G. Gabos MD
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Corresponding author

Correspondence to Suken A. Shah MD.

Additional information

Author disclosures: SAS (grant from the Setting Scoliosis Straight Foundation; provision of writing assistance, medicines, equipment, or administrative support from Harms Study Group; board membership with Scoliosis Research Society and Setting Scoliosis Straight Foundation; patents from DePuy Synthes Spine; AAD (none); JEO (none); PY (none); GIN (none); LH (none); PGG (payment for lecture from DePuy Synthes Spine).

Corporate or industry funds were received to support this work. Although one or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript, benefits will be directed solely to a research fund, foundation, educational institution, or other nonprofit organization that the author(s) has/have been associated with.

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Shah, S.A., Dhawale, A.A., Oda, J.E. et al. Ponte Osteotomies With Pedicle Screw Instrumentation in the Treatment of Adolescent Idiopathic Scoliosis. Spine Deform 1, 196–204 (2013). https://doi.org/10.1016/j.jspd.2013.03.002

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  • DOI: https://doi.org/10.1016/j.jspd.2013.03.002

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