Ponte osteotomies in a matched series of large AIS curves increase surgical risk without improving outcomes

Scoliosis Round Table: What are Your Optimal Surgical Strategies for a Double Major Curve in Adolescent Idiopathic Scoliosis?

“…20 We recently compared a matched group of larger AIS curves averaging 70 degrees demonstrating improvement of 7% of coronal plane correction, with no differences in improvement in sagittal plane correction or clinical rotational deformity correction or SRS-22 scores. 21 What we did find was a significant increase in the incidence of intraoperative neuromonitoring changes, increased blood loss and operative time, findings seen with other studies as well. There is no doubt there is value in performing these osteotomies in large curves with significant deformity or in scenarios in which full correction is desired such as a large lumbar curve in which these osteotomies may have greater value as the restriction of the thoracic cage does not limit the flexibility provided by the osteotomy.…”

Posterior Column Osteotomies in Adolescent Idiopathic Scoliosis

“…16 In a singlecenter matched cohort of 68 patients, PCO provided no improvement in the sagittal or axial planes, only 8% improvement in coronal plane correction, and higher risk of critical neuromonitoring changes (15% with PCO vs. 0% without, p=0.05) with no difference in health-related quality of life (HRQoL). 18 Other studies have likewise identified PCOs as an independent risk factor for intraoperative neuromonitoring (IONM) changes. 25,26 Buckland et al found that PCOs are an independent risk factor for IONM alerts (9.3% vs. 4.2%, p<0.001), though this did not manifest into a significantly different incidence of postoperative neurologic deficit (0.37% with PCO vs. 0.17% without, p=0.45).…”

“…• FOR BOTH TECHNIQUES: Consider placement of bone graft substitute "strips" (Figure 6) over the exposed neural elements to protect the dura and spinal cord from particulate bone graft, as there have been reports of bone graft impinging on the cord at the PCO site contributing to critical IONM alerts. 18 Other alternatives include gel foam (See Video). Other clinical studies have demonstrated little benefit from PCOs but potentially increased surgical risk.…”

“…[11][12][13][14][15] However, the routine use of PCO for AIS remains controversial, with conflicting data as to the necessity, efficacy, and safety of this practice. [16][17][18]…”

Posterior Column Osteotomies in Adolescent Idiopathic Scoliosis: Panel Discussion

“…We also matched patients with large curves and found no difference in restoration of thoracic kyphosis and very small gains in the coronal plane. 4 I think the best data we have today doesn't speak to the use of PCOs for thoracic scoliosis and we have to be really careful about routinely recommending them in idiopathic scoliosis for any good data-driven reason.…”