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

Sangiorgio, Sophia N.; Borkowski, Sean L.; Bowen, Richard E.; Scaduto, Anthony A.; Frost, Nathan; Ebramzadeh, Edward

doi:10.1016/j.jspd.2013.01.006

Cited by 43 publications

(14 citation statements)

References 34 publications

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“…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]. Therefore, the apical and the first cephalad and caudal segments were selected as the candidate region for Ponte osteotomy in all cases.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Purpose The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients. Methods We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome. Results The average follow-up was 2.9 years (range 2–3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up. Conclusions Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw–bone interface and optimizing corrective potential.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…As a result, the effect of the transfer in the cadaver specimens may not precisely reproduce the effect that may be seen in the clinical situation. However, adult specimens have been used in place of pediatric specimens in several published studies and have provided meaningful results [12,15,23]. Second, anatomic positioning of each specimen had to be approximated, and to minimize variability in the data, the same positioning method was used for each trial.…”

Section: Discussionmentioning

confidence: 99%

“…The software calculates the 3-D position for each marker and displays its coordinates in real time. This motion tracking system has an accuracy of 0.1 mm, a resolution of 0.01 mm at a distance of 2.25 m, and has been used in previous studies [4,23]. Motion-tracker flags were created by mounting four LED markers equidistant from the center of a 1.5-inch square plastic fixture, creating a noncollinear 1-inch-square arrangement.…”

Section: Methodsmentioning

confidence: 99%

How Do Different Anterior Tibial Tendon Transfer Techniques Influence Forefoot and Hindfoot Motion?

Knutsen

Avoian

Sangiorgio

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Idiopathic clubfoot correction is commonly performed using the Ponseti method and is widely reported to provide reliable results. However, a relapsed deformity may occur and often is treated in children older than 2.5 years with repeat casting, followed by an anterior tibial tendon transfer. Several techniques have been described, including a whole tendon transfer using a two-incision technique or a three-incision technique, and a split transfer, but little is known regarding the biomechanical effects of these transfers on forefoot and hindfoot motion. Questions/purpose We used a cadaveric foot model to test the effects of three tibialis anterior tendon transfer techniques on forefoot positioning and production of hindfoot valgus. MethodsTen fresh-frozen cadaveric lower legs were used. We applied 150 N tension to the anterior tibial tendon, causing the ankle to dorsiflex. Three-dimensional motions of the first metatarsal, calcaneus, and talus relative to the tibia were measured in intact specimens, and then repeated after each of the three surgical techniques. Results Under maximum dorsiflexion, the intact specimens showed 6°(95% CI, 2.2°-9.4°) forefoot supination and less than 3°(95% CI, 0.4°-5.3°) hindfoot valgus motion. All three transfers provided increased forefoot pronation and hindfoot valgus motion compared with intact specimens: the three-incision whole transfer provided 38°( 95% CI, 33°-43°; p \ 0.01) forefoot pronation and 10°( 95% CI, 8.5°-12°; p \ 0.01) hindfoot valgus; the split transfer, 28°(95% CI, 24°-32°; p \ 0.01) pronation, 9°( 95% CI, 7.5°-11°; p \ 0.01) valgus; and the two-incision transfer, 25°(95% CI, 20°-31°; p \ 0.01) pronation, 6°( 95% CI, 4.2°-7.8°; p \ 0.01) valgus.

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“…However, cadaveric biomechanical evidence suggests that PCO have a small effect on the coronal flexibility of the thoracic spine but notable effect on the sagittal flexibility of the intact spine. 38 Resection of the posterior column tension band with PCOs transitions the axis of rotation anteriorly, detethers the posterior elements, and enables dorsal lengthening, all of which facilitates restoration of TK at the apical lordosis of the thoracic curve apex. Apical PCOs have been advocated as an integral component of the multimodal surgical approach to restore TK in hypokyphotic patients.…”

Section: Posterior Column Osteotomiesmentioning

confidence: 99%

The Sagittal Plane in Spinal Fusion for Adolescent Idiopathic Scoliosis

Ritzman

Floccari

2022

J Am Acad Orthop Surg

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Sagittal balance is widely recognized as the primary determinant of optimal outcomes in adult spinal deformity. In adolescent idiopathic scoliosis (AIS), coronal correction risks being obtained at the expense of sagittal malalignment after posterior spinal fusion. Apical lordosis, often underestimated on two-dimensional imaging, is the primary deforming factor in AIS. Failure to restore thoracic kyphosis and lumbar lordosis during posterior spinal fusion contributes to problematic early surgical complications, including proximal or distal junctional kyphosis and failure. Although adolescent patients often compensate for sagittal imbalance in the short-term and mid-term, late sequelae of iatrogenic sagittal imbalance include flatback syndrome, disk degeneration, cervical kyphosis, and late decompensation. Objective criteria using spinopelvic parameters and preoperative three-dimensional planning can guide sagittal plane correction during PSF for AIS. Technical caveats can help avoid sagittal plane complications, including instrumentation level selection, anchor type, and anatomic protection of adjacent levels. Other surgical techniques to optimize restoration of thoracic kyphosis include higher implant density, stiffer rod material, Ponte osteotomies, and deformity correction technique.

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

Cited by 43 publications

References 34 publications

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

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

How Do Different Anterior Tibial Tendon Transfer Techniques Influence Forefoot and Hindfoot Motion?

The Sagittal Plane in Spinal Fusion for Adolescent Idiopathic Scoliosis

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