One-Stage Posterior Multiple-Level Asymmetrical Ponte Osteotomies Versus Single-Level Posterior Vertebral Column Resection for Severe and Rigid Adult Idiopathic Scoliosis

Abstract

Study Design. Retrospective comparative study. Objective. 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). Summary of Background Data. 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. Methods. 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. Results. 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. Conclusion. 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. Level of Evidence: 3

Outcome of Posterior-Only Approach for Severe Rigid Scoliosis: A Retrospective Report

“…A single-level osteotomy will not affect the flexibility of the spinal segment above and below the osteotomy and cannot achieve 3-dimensional correction of spinal deformity. In a retrospective study, Zhang et al 34 compare the efficacy and safety of posterior multiple-level asymmetrical Ponte osteotomies and posterior vertebral column resection for severe and rigid adult idiopathic scoliosis, and they suggested that multiple asymmetrical Ponte osteotomy is a safe, easy-tooperate, and effective technique that can gain correction outcomes similar to those of VCR, offering the advantages of reduced complications, operation time, and blood loss. Some authors 29 have performed apical Smith Peterson osteotomy for thoracic scoliosis with more than 1008.…”

Outcomes of Oblique Lateral Interbody Fusion for Adult Spinal Deformity: A Systematic Review and Meta-Analysis

“…Schwab et al 32 proposed classification system of spinal osteotomy based on 6 anatomic grades of resection corresponding to the extent of bone resection. The extent of PCO including SPO 2 (grade I) and Ponte osteotomy 33 (grade II) is small, which corrects spinal deformity by removing articular processes. PSO 2 (grade Ⅲ), SRS-Schwab osteotomy 34 (grade Ⅳ), VCR 3 (grade Ⅴ) and multiple VCRs (grade Ⅵ) belong to 3-column osteotomy.…”

Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series

“…The use of the original Ponte osteotomy for the treatment of rigid AdIS has been well documented in the literature [10][11][12][13]. Clinical and cadaver studies have shown marked segmental flexibility in all three planes produced by Ponte osteotomy [22][23][24].…”

“…The aim of this article is to describe the innovative posterior one stage surgical technique summarized with the acronym Hi-PoAD, which consists of simultaneous application of different surgical strategies, all well described individually, as high-density screwing [6][7][8][9], Ponte osteotomies [10][11][12][13], asymmetric rods contouring [14][15][16], direct vertebral rotation (DVR) [17] in the treatment of rigid AdIS (with less than 25% of correction at bending supine radiographs), the complication rate and the clinical and radiographical results obtained at minimum 2 years follow-up (FU) in a cohort of patients over 40 years treated.…”