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Nasto LA, Mousavi Nasab SH, Sieczak A, Cattolico A, Ulisse P, Pola E. Ponte osteotomies for treatment of spinal deformities: they are not all made equal. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08334-2. [PMID: 38822151 DOI: 10.1007/s00586-024-08334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/23/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
PURPOSE To compare surgical outcomes of Ponte's osteotomies for treatment of adolescent idiopathic scoliosis (AIS), Scheuermann's kyphosis (SK), and adult scoliosis (AdS). METHODS We conducted a retrospective review of patients with AIS, SK, and AdIS who underwent posterior spinal instrumented fusion (PSIF) at our Institution from January 2019 to December 2022. Demographics, imaging, and intraoperative data (including number of osteotomies performed, blood losses, surgical timing, and complications) were extracted from patient charts. RESULTS A total of 80 patients (62 AIS, 7 SK, and 11 AdS) were enrolled in the study. All patients were treated with a PSIF and a total of 506 Ponte osteotomies were performed (5.8 ± 4.1, 9.3 ± 2.4, and 7.5 ± 2.5 average osteotomies per patient in the AIS, SK, and AdS group, respectively; p = 0.045). Average time per osteotomy was 6.3 ± 1.5 min in the AIS group, and 5.8 ± 2.1 and 8.7 ± 4.0 in the SK and AdS group, respectively (p = 0.002). Blood loss was significantly smaller in the SK group (8.6 ± 9.6 ml per osteotomy) compared to AIS group (34.9 ± 23.7 ml) and AdS group (34.9 ± 32.7 ml) (p = 0.001). A total of 4 complications were observed in the AIS group (1.1%) and 2 complications in the AdS group (2.4%), but this was not statistically significant. CONCLUSIONS Our study shows that Ponte's osteotomies are safe and effective in surgical treatment of AIS, SK, and AdS. Blood loss and execution time per osteotomy are significantly smaller in the SK group compared to AIS and AdS. No significant differences were noted in terms of complications between the three groups.
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Affiliation(s)
- Luigi Aurelio Nasto
- Department of Orthopaedics, Azienda Ospedaliera Universitaria "Luigi Vanvitelli", Università degli Studi della Campania "Luigi Vanvitelli" School of Medicine, Piazza Luigi Miraglia 2, Padiglione 3 Est, 1° Piano, 80138, Naples, Italy.
| | - Seyed Hirbod Mousavi Nasab
- Department of Orthopaedics, Azienda Ospedaliera Universitaria "Luigi Vanvitelli", Università degli Studi della Campania "Luigi Vanvitelli" School of Medicine, Piazza Luigi Miraglia 2, Padiglione 3 Est, 1° Piano, 80138, Naples, Italy
| | - Angelo Sieczak
- Department of Orthopaedics, Azienda Ospedaliera Universitaria "Luigi Vanvitelli", Università degli Studi della Campania "Luigi Vanvitelli" School of Medicine, Piazza Luigi Miraglia 2, Padiglione 3 Est, 1° Piano, 80138, Naples, Italy
| | - Alessandro Cattolico
- Department of Orthopaedics, Azienda Ospedaliera Universitaria "Luigi Vanvitelli", Università degli Studi della Campania "Luigi Vanvitelli" School of Medicine, Piazza Luigi Miraglia 2, Padiglione 3 Est, 1° Piano, 80138, Naples, Italy
| | - Paolo Ulisse
- Department of Orthopaedics, Azienda Ospedaliera Universitaria "Luigi Vanvitelli", Università degli Studi della Campania "Luigi Vanvitelli" School of Medicine, Piazza Luigi Miraglia 2, Padiglione 3 Est, 1° Piano, 80138, Naples, Italy
| | - Enrico Pola
- Department of Orthopaedics, Azienda Ospedaliera Universitaria "Luigi Vanvitelli", Università degli Studi della Campania "Luigi Vanvitelli" School of Medicine, Piazza Luigi Miraglia 2, Padiglione 3 Est, 1° Piano, 80138, Naples, Italy
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Kim SM, Kim YC, Kim KT, Ha KY, Luo Q, Li X, Park J. Surgical sequence in anterior column realignment with posterior osteotomy is important for degree of adult spinal deformity correction: advantages and indications for posterior to anterior sequence. BMC Musculoskelet Disord 2022; 23:1004. [PMID: 36419151 PMCID: PMC9682648 DOI: 10.1186/s12891-022-05915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/28/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We hypothesized that posterior osteotomy prior to ACR (Anterior column realignment) through P-A-P surgical sequence would permit a greater correction for deformity corrective surgery than the traditional A-P sequence without posterior osteotomy. This study aimed to determine the impact of the P-A-P sequence on the restoration of lumbar lordosis (LL) compared to the A-P sequence in deformity corrective surgery for adult spinal deformity (ASD) patients and to identify the characteristics of patients who require this sequence. METHODS: Between 2017 and 2019, 260 ASD patients who had undergone combined corrective surgery were reviewed retrospectively. This study included 178 patients who underwent posterior osteotomy before the ACR (P-A group) and 82 patients who underwent the A-P sequence (A-P group). Sagittal spinopelvic parameters were determined from pre- and postoperative whole-spine radiographs and compared between the groups. To find better indications for the P-A-P sequence, we conducted additional analysis on postoperative outcomes of patients in the A-P group. RESULTS: The P-A group showed a significantly higher change in LL (53.7° vs. 44.3°, p < 0.001), C7 sagittal vertical axis (C7 SVA: 197.4 mm vs. 146.1 mm, p = 0.021), segmental lordosis (SL) L2/3 (16.2° vs. 14.4°, p = 0.043), SL L3/4 (16.2° vs. 13.8°, p = 0.004), and SL L4/5 (15.1° vs. 11.3°, p = 0.001) compared to the A-P group. At the final follow-up, pelvic incidence (PI) minus LL mismatch (PI - LL mismatch) was significantly higher in the A-P group (13.4° vs. 2.9°, p < 0.001). Stepwise logistic regression analysis showed that age ≥ 75 years (odds ratio [OR] = 2.151; 95% confidence interval [CI], 1.414-3.272; p < 0.001), severe osteoporosis (OR = 2.824; 95% CI, 1.481-5.381; p = 0.002), rigid lumbar curve with dynamic changes in LL < 10° (OR = 5.150; 95% CI, 2.296-11.548; p < 0.001), and severe facet joint osteoarthritis (OR = 4.513; 95% CI, 1.958-10.402; p < 0.001) were independent risk factors for PI - LL mismatch ≥ 10° after A-P surgery. CONCLUSION P-A-P sequence for deformity corrective surgery in ASD offers greater LL correction than the A-P sequence. Indications for the procedure include patients aged ≥ 75 years, severe osteoporosis, rigid lumbar curve with dynamic change in LL < 10°, or more than four facet joints of Pathria grade 3 in the lumbar region.
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Affiliation(s)
- Sung-Min Kim
- grid.289247.20000 0001 2171 7818Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, 05278 Seoul, Korea
| | - Yong-Chan Kim
- grid.289247.20000 0001 2171 7818Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, 05278 Seoul, Korea
| | - Ki-Tack Kim
- grid.289247.20000 0001 2171 7818Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, 05278 Seoul, Korea
| | - Kee-Yong Ha
- grid.289247.20000 0001 2171 7818Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, 05278 Seoul, Korea
| | - Qiang Luo
- grid.289247.20000 0001 2171 7818Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, 05278 Seoul, Korea ,grid.289247.20000 0001 2171 7818Department of Orthopaedic Surgery, Graduate School of Medicine, Kyung Hee University, Kyungheedae-ro, Dongdaemun-gu, Seoul, Korea
| | - Xiongjie Li
- grid.289247.20000 0001 2171 7818Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, 05278 Seoul, Korea ,grid.289247.20000 0001 2171 7818Department of Orthopaedic Surgery, Graduate School of Medicine, Kyung Hee University, Kyungheedae-ro, Dongdaemun-gu, Seoul, Korea
| | - JunBum Park
- grid.289247.20000 0001 2171 7818Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, 05278 Seoul, Korea
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Floccari LV, Poppino K, Greenhill DA, Sucato DJ. Ponte osteotomies in a matched series of large AIS curves increase surgical risk without improving outcomes. Spine Deform 2021; 9:1411-1418. [PMID: 33861426 DOI: 10.1007/s43390-021-00339-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/24/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The routine use of Ponte osteotomies in adolescent idiopathic scoliosis (AIS) surgery is controversial with conflicting data for coronal plane correction and little analysis in the sagittal plane. The objective of this study was to analyze the efficacy of Ponte osteotomies in large curve AIS. METHODS A single institution, prospectively-collected series of consecutive AIS patients who had Ponte osteotomies (P cohort) was directly matched to patients with no Pontes (NP cohort) by age, gender, Lenke classification, surgeon, coronal, and sagittal Cobb angles. The radiographic review included adjusted values using a 3D-derived published formula for preoperative T5-T12 kyphosis. Patient-reported outcomes (PROs) were assessed with the SRS-30 and Spinal Appearance Questionnaire (SAQ). RESULTS There were 68 patients (34/cohort) with minimum 2-year follow-up with no differences between P and NP cohorts in age, preoperative coronal Cobb (74.5° vs 70.8°), flexibility index, measured or 3D-adjusted T5-T12 kyphosis. Rod material/diameter, fusion levels, blood loss, and operative time did not differ, but implant density was higher in the P group (1.53 vs 1.31, p < 0.001). The P group had 7.9% greater coronal Cobb correction (66.6% vs 58.7%, p < 0.003) without difference in final Cobb angles (24.7° vs. 29.1°, p = 0.052). There were no differences in measured or adjusted T5-T12 kyphosis in the sagittal plane. The P group had a 15% rate of critical intraoperative neuromonitoring changes versus 0% in the NP group (p = 0.053). At follow-up, there were no differences in scoliometer measurements or any domain of SRS-30 or SAQ scores. CONCLUSION In this first reported matched series of AIS patients, Ponte osteotomies provide small radiographic gains in the coronal plane with no improvement in the sagittal plane and no change in truncal rotation. There was a higher risk of critical intraoperative neuromonitoring changes, and no benefits in patient-reported outcomes. This calls into question the routine use of Ponte osteotomies in AIS, even for curves averaging 70 degrees. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Lorena V Floccari
- Department of Orthopedic Surgery, Akron Children's Hospital, Akron, OH, USA
| | - Kiley Poppino
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Dustin A Greenhill
- Department of Orthopedic Surgery, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Daniel J Sucato
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX, 75219, USA.
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Sangiorgio SN, Borkowski SL, Day MJ, Ho NC, Knutsen A, Scaduto AA, Bowen RE, Ebramzadeh E. Increasing loads and diminishing returns: a biomechanical study of direct vertebral rotation. Spine Deform 2020; 8:577-584. [PMID: 32026440 DOI: 10.1007/s43390-020-00061-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Biomechanical simulation of DVR and pure-moment testing on thoracic spines. OBJECTIVES Characterize load-deformation response of thoracic spines under DVR maneuvers until failure, and compare to pure-moment testing of same spines. Despite reports of surgical complications, few studies exist on increase in ROM under DVR torque. Biomechanical models predicting increases from surgical releases have consistently used "pure-moments", a standard established for non-destructive measurement of ROM. Yet, DVR torque is not accurately modeled using pure moments and, moreover, magnitudes of torque applied during DVR maneuvers may be substantially higher than pure-moment testing. METHODS Cadaveric thoracic spines (N = 11) were imaged, then prepared. Polyaxial pedicle screws were implanted at T7-T10 after surgical releases. Bilateral facetectomies and Ponte osteotomies were completed at T10-T11. A custom apparatus, mounted into an 8-dof MTS load frame, was used to attach to pedicle screws, allowing simulation of surgical DVR maneuvers. Motions of vertebrae were measured using optical motion tracking. Torque was increased until rupture of the T10-T11 disc or fracture at the pedicle screw sites at any level. The torque-rotation behavior was compared to its behavior under pure-moment testing performed prior to the DVR maneuver. RESULTS Under DVR maneuvers, failure of the T10-T11 discs accompanied in most cases by pedicle screw loosening, occurred at 13.7-54.7 Nm torque, increasing axial rotation by 1.4°-8.9°. In contrast, pure-moment testing (4 Nm) increased axial rotation by only 0.0°-0.9°. CONCLUSIONS DVR resulted in substantially greater correction potential increases compared to pure-moment testing even at the same torque. These results suggest increased flexibility obtained by osteotomies and facetectomies is underestimated using pure-moment testing, misrepresenting clinical expectations. The present study is an important and necessary step toward the establishment of a more accurate and ultimately surgically applied model. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sophia N Sangiorgio
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center (JVL), Orthopaedic Institute for Children (OIC)/UCLA, Los Angeles, CA, USA
| | | | - Matthew J Day
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center (JVL), Orthopaedic Institute for Children (OIC)/UCLA, Los Angeles, CA, USA.
| | - Nathan C Ho
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center (JVL), Orthopaedic Institute for Children (OIC)/UCLA, Los Angeles, CA, USA
| | - Ashleen Knutsen
- University of Southern California (USC), Los Angeles, CA, USA
| | - Anthony A Scaduto
- Orthopaedic Institute for Children (OIC) and the Department of Orthopaedic Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Richard E Bowen
- Orthopaedic Institute for Children (OIC) and the Department of Orthopaedic Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Edward Ebramzadeh
- J. Vernon Luck Sr, M.D. Orthopaedic Research Center (JVL), Orthopaedic Institute for Children (OIC)/UCLA, Los Angeles, CA, USA
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One-Stage Posterior Multiple-Level Asymmetrical Ponte Osteotomies Versus Single-Level Posterior Vertebral Column Resection for Severe and Rigid Adult Idiopathic Scoliosis: A Minimum 2-Year Follow-up Comparative Study. Spine (Phila Pa 1976) 2019; 44:E1196-E1205. [PMID: 31415466 DOI: 10.1097/brs.0000000000003101] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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.
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Biomechanical Analysis of Wide Posterior Releases Compared With Inferior Facetectomy and Discectomy in the Thoracolumbar and Lumbar Spine. Spine Deform 2019; 7:404-409. [PMID: 31053310 DOI: 10.1016/j.jspd.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/07/2018] [Accepted: 09/03/2018] [Indexed: 11/21/2022]
Abstract
STUDY DESIGN In vitro biomechanical analysis. OBJECTIVES Compare the destabilizing effects of anterior discectomy to posterior spinal releases. SUMMARY OF BACKGROUND DATA Posterior release and pedicle screw fixation has become the accepted form of treatment for lumbar and thoracolumbar pediatric scoliotic spinal deformity. A biomechanical evaluation of posterior releases with comparison to traditional anterior releases has not been reported in the lumbar spine. METHODS Eleven fresh-frozen human thoracolumbar specimens (T9-L5) were tested by a robotic manipulator (Staubli RX90; moment target of 5.0 Nm, force target of 50 N) in axial rotation (AR), plus lateral and anterior translation (LT and AT). Specimens underwent either sequential anterior release (partial and full discectomy) or posterior release (inferior facetectomy and wide posterior release) from T10 to L4. Partial discectomy retained the posterior 50% of disc and posterior longitudinal ligament, whereas full discectomy removed all of the disc and PLL. Wide posterior release included total facetectomy plus ligamentum flavum and spinous process resection. RESULTS Inferior facetectomy produced an average increase of 1.5° ± 1.0° (p = .0625), 1.0 ± 0.8 mm (p = .0313), and 0.2 ± 0.3 mm (p = .156) in AR, LT, and AT, respectively. Compared with partial facetectomy, wide posterior release produced an average additional increase of 8.1° ± 4.0° (p = .0312), 2.0 ± 2.2 mm (p = .4062), and 1.1 ± 1.0 mm (p = .0625) in AR, LT, and AT, respectively. Full discectomy produced 201%, 161%, and 153% of the motion relative to wide posterior release in AR, LT, and AT, respectively (p = .0043, .0087, and .0173). Partial discectomy and wide posterior release proved statistically equivalent. CONCLUSIONS Wide posterior release of the thoracolumbar spine allows significant correction and may be superior to inferior facetectomy in axial rotation. Although complete discectomy with PLL resection would likely allow greater correction, a more clinically realistic partial discectomy confers similar corrective potential in vitro compared with wide posterior release. LEVEL OF EVIDENCE Not applicable.
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Zhang Y, Hai Y, Tao L, Yang J, Zhou L, Yin P, Pan A, Zhang Y, Liu C. Posterior Multiple-Level Asymmetrical Ponte Osteotomies for Rigid Adult Idiopathic Scoliosis. World Neurosurg 2019; 127:e467-e473. [PMID: 30922897 DOI: 10.1016/j.wneu.2019.03.173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/15/2019] [Accepted: 03/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of posterior multiple-level asymmetrical Ponte osteotomies for rigid adult idiopathic scoliosis. METHODS A retrospective study was conducted for adult patients with rigid idiopathic scoliosis (flexibility of main curve <25%) who underwent one-stage multiple-level asymmetrical Ponte osteotomies with a minimum of 2-year follow-up between February 2009 and November 2015. The demographic data and surgical issues were collected, and the improvement of clinical function scores and radiologic parameters were obtained after surgery and during the follow-up to assess deformity correction, spinal balance, and clinical outcome. RESULTS A total of 49 patients were included (10 male and 39 female) in this study, with an average age of 26.53 years old. The average follow-up was 28.37 ± 6.98 months. All the cases presented a significant improvement of the main curve and focal kyphosis from 85.62 ± 19.80° to 36.19 ± 16.74° and 53.98 ± 26.80° to 30.88 ± 18.69°, with a mean correction rate of 57.73% and 41.23%. The postoperative coronal and sagittal parameters were all significantly improved, except coronal balance. The mean operative time and blood loss were 267.86 ± 54.49 minutes and 838.78 ± 538.93 mL. All the clinical function scores of patients were significantly improved at the final follow-up. Only one patient had a complication related to surgical incision, with no neurologic complications occurring. CONCLUSIONS The surgical procedure of multiple-level asymmetrical Ponte osteotomy is a safe and effective technique, with reduced operation time, blood loss, and complications, and may offer an appropriate option to address the problems of rigid adult idiopathic scoliosis.
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Affiliation(s)
- Yangpu Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China.
| | - Luming Tao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Jincai Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Lijin Zhou
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Peng Yin
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Yaoshen Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Chang Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Chaoyang District, Beijing, China
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Selection of posterior spinal osteotomies for more effective periapical segmental vertebral derotation in adolescent idiopathic scoliosis-An in vivo comparative analysis between Ponte osteotomy and inferior facetectomy alone. J Orthop Sci 2018; 23:488-494. [PMID: 29478623 DOI: 10.1016/j.jos.2018.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Ponte osteotomy is a useful method in posterior spinal release. However, it is unclear whether Ponte osteotomy itself contributes to vertebral derotation in surgery for adolescent idiopathic scoliosis (AIS) patients compared to inferior facetectomy alone. This study aimed to assess the effect of Ponte osteotomy on the magnitude of periapical vertebral body rotation compared to inferior facetectomy alone. This study was a prospective collected data. METHODS The study included 63 patients with AIS (Thoracic curve type, 35; thoracolumbar/lumbar curve type, 27), who underwent surgery between August 2011 and January 2015. All AIS patients underwent posterior spinal fusion with uniplanar screws and Ponte osteotomies on three periapical intervertebral segments. We measured and analyzed the flexibility of periapical intervertebral rotation pre- and post-bilateral inferior facetectomy, and post-Ponte osteotomy with our device (three times). The difference in intervertebral rotation between pre- and post-Ponte osteotomy was analyzed. RESULTS The mean increase in angle was 5.6° for thoracic curves and 6.4° for thoracolumbar curves. The increase in angle for thoracolumbar curves was significantly larger than that for thoracic curves (P < 0.05). The more an apical region of the scoliosis was located at caudal side of spine, the more the flexibility due to Ponte osteotomy increased (P < 0.05). The significant differences of the increase in intervertebral flexibility between inferior facetectomies and Ponte osteotomies were recognized at middle thoracic and thoracolumbar regions (P < 0.005). CONCLUSIONS Our data suggest that Ponte osteotomy has a loosening effect on periapical scoliotic curvature compared to inferior facetectomy alone. Ponte osteotomy is likely to be associated with an increase in loosening of the middle thoracic and thoracolumbar regions.
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Ponte A, Orlando G, Siccardi GL. The True Ponte Osteotomy: By the One Who Developed It. Spine Deform 2018; 6:2-11. [PMID: 29287812 DOI: 10.1016/j.jspd.2017.06.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/23/2017] [Indexed: 10/18/2022]
Abstract
STUDY DESIGN Technique and applications. OBJECTIVES To define the anatomy, biomechanics, indications, and surgical technique of the true Ponte osteotomy. SUMMARY OF BACKGROUND DATA The Ponte osteotomy, originally developed for thoracic kyphosis, was the first one to obtain posterior shortening of the thoracic spine, maintaining the anterior column load-sharing capacity. It has become a widely applied technique in various types of spine deformities and a frequent topic of presentations at meetings and in scientific articles. Several of them offer unquestionable evidence of an incorrect execution, with consequently distorted outcomes and erroneous conclusions. A clearing up became essential. METHODS Our original experience is based on a series of 240 patients with thoracic hyperkyphosis operated in the years 1969-2015, at first with a standard posterior Harrington technique and then by using the Ponte osteotomy with different instrumentations. A series of 78 of them, operated in the years 1987-1997, who had Ponte osteotomies at every level, is presented. RESULTS The average preoperative kyphosis has been corrected from 80° (range 61°-102°) to 31° (range 15°-50°) by a substantial posterior shortening. CONCLUSIONS A number of publications use the term Ponte osteotomy loosely for by far incomplete resections and mixing it up with Smith-Petersen's osteotomy. The true Ponte osteotomy is capable of producing marked flexibility in extension, flexion and rotation, justifying its wide use in thoracic deformities, mainly in scoliosis. An exact performance of the osteotomy with adequate bony resections, including the laminae, is an absolute condition to take full advantage of its properties. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Alberto Ponte
- Stuart Clinic, 5952 Via Trionfale, Rome 00136, Italy.
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Han S, Hyun SJ, Kim KJ, Jahng TA, Kim HJ, Lee BH, Choi HY. Multilevel Posterior Column Osteotomies Are Not Inferior For the Correction of Rigid Adult Spinal Deformity Compared with Pedicle Subtraction Osteotomy. World Neurosurg 2017; 107:839-845. [PMID: 28847551 DOI: 10.1016/j.wneu.2017.08.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Posterior column osteotomy (PCO) has been used for the correction of various spinal deformities. However, little evidence is available regarding the effects of multilevel PCO in adult spinal deformity (ASD) surgery. This study aimed to show the usefulness of PCO in rigid ASD surgery by assessing radiographic and clinical outcomes. We also aimed to assess the corrective potential of multilevel PCOs compared with a single-level pedicle subtraction osteotomy (PSO). METHODS Between 2012 and 2016, the medical records of 70 consecutive patients who underwent a multilevel PCO (35 patients) or a single-level PSO (35 patients) for ASD in a single institute were reviewed. Baseline data, radiographic measurements, and clinical outcomes using the Scoliosis Research Society-22 (SRS-22) questionnaire were compared between groups. RESULTS The following variables were no different between the groups: age at surgery, sex, level fused, preoperative and postoperative radiologic parameters, and bone mineral density T score. However, operation time (380.0 vs. 483.6 minutes), estimated blood loss (1175.7 vs. 1362.6 mL), and the number of complications (8 vs. 20) were significantly reduced in the PCO group compared with the PSO group. A significant improvement in the SRS-22 score was seen in both groups after surgery, although no difference was observed between the groups postoperatively. CONCLUSIONS Multilevel PCOs for the correction of rigid ASD were slightly superior to PSO, regarding clinical outcomes. Radiographic outcomes were similar between groups. Thus, multilevel PCOs may be a viable option for the treatment of rigid ASD with a mobile segment.
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Affiliation(s)
- Sanghyun Han
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Byoung Hun Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ho Yong Choi
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
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Abstract
Correction manoeuvres are as important as the other issues such as hardware selection, graft options, fusion and osteotomy techniques in the surgical treatment of spinal deformities.The property of materials demonstrating both viscous and elastic characteristics when undergoing deformation is called visco-elasticity. Purely elastic materials change in shape with a stress, and go back to their initial form when the stress is removed. However, visco-elastic materials, like the spine, may protect their new formation unless a back stress is applied. Time is a very important parameter during manoeuvre application to the spine because of its visco-elastic behavior.The most common correction manoeuvres that can be used for spinal deformities are rod de-rotation, distraction-compression, in situ rod bending, segmental de-rotation, en bloc de-rotation and cantilever.Spontaneous correction of a minor curve is possible after selective fusion of a major curve due to coupling phenomenon. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.170002. Originally published online at www.efortopenreviews.org.
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Affiliation(s)
| | - Mehmet Cetinkaya
- Erzincan University, Mengucek Gazi Education and Research Hospital, Erzincan, Turkey
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Wang X, Larson AN, Crandall DG, Parent S, Labelle H, Ledonio CGT, Aubin CE. Biomechanical effect of pedicle screw distribution in AIS instrumentation using a segmental translation technique: computer modeling and simulation. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:13. [PMID: 28428982 PMCID: PMC5393020 DOI: 10.1186/s13013-017-0120-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 03/28/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Efforts to select the appropriate number of implants in adolescent idiopathic scoliosis (AIS) instrumentation are hampered by a lack of biomechanical studies. The objective was to biomechanically evaluate screw density at different regions in the curve for AIS correction to test the hypothesis that alternative screw patterns do not compromise anticipated correction in AIS when using a segmental translation technique. METHODS Instrumentation simulations were computationally performed for 10 AIS cases. We simulated simultaneous concave and convex segmental translation for a reference screw pattern (bilateral polyaxial pedicle screws with dorsal height adjustability at every level fused) and four alternative patterns; screws were dropped respectively on convex or concave side at alternate levels or at the periapical levels (21 to 25% fewer screws). Predicted deformity correction and screw forces were compared. RESULTS Final simulated Cobb angle differences with the alternative screw patterns varied between 1° to 5° (39 simulations) and 8° (1 simulation) compared to the reference maximal density screw pattern. Thoracic kyphosis and apical vertebral rotation were within 2° of the reference screw pattern. Screw forces were 76 ± 43 N, 96 ± 58 N, 90 ± 54 N, 82 ± 33 N, and 79 ± 42 N, respectively, for the reference screw pattern and screw dropouts at convex alternate levels, concave alternate levels, convex periapical levels, and concave periapical levels. Bone-screw forces for the alternative patterns were higher than the reference pattern (p < 0.0003). There was no statistical bone-screw force difference between convex and concave alternate dropouts and between convex and concave periapical dropouts (p > 0.28). Alternate dropout screw forces were higher than periapical dropouts (p < 0.05). CONCLUSIONS Using a simultaneous segmental translation technique, deformity correction can be achieved with 23% fewer screws than maximal density screw pattern, but resulted in 25% higher bone-screw forces. Screw dropouts could be either on the convex side or on the concave side at alternate levels or at periapical levels. Periapical screw dropouts may more likely result in lower bone-screw force increase than alternate level screw dropouts.
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Affiliation(s)
- Xiaoyu Wang
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada.,Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, Quebec H3T 1C5 Canada
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 USA
| | - Dennis G Crandall
- Sonoran Spine Center and Research Foundation, 1255 W Rio Salado Pkwy, Suite 107, Tempe, AZ 85281 USA
| | - Stefan Parent
- Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, Quebec H3T 1C5 Canada
| | - Hubert Labelle
- Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, Quebec H3T 1C5 Canada
| | - Charles G T Ledonio
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454 USA
| | - Carl-Eric Aubin
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, Quebec H3C 3A7 Canada.,Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, Quebec H3T 1C5 Canada
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13
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Influence of Sequential Ponte Osteotomies on the Human Thoracic Spine With a Rib Cage. Spine Deform 2017; 5:91-96. [PMID: 28259271 DOI: 10.1016/j.jspd.2016.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/07/2016] [Accepted: 10/12/2016] [Indexed: 11/20/2022]
Abstract
STUDY DESIGN Biomechanical cadaveric study. OBJECTIVES The purpose of this study was to determine the change in range of motion (ROM) of the human thoracic spine and rib cage due to sequential Ponte osteotomies (POs). SUMMARY OF BACKGROUND DATA POs are often performed in deformity correction surgeries to provide flexibility in the sagittal plane at an estimated correction potential of 5° per PO, but no studies have evaluated the biomechanical impact of the procedure on a cadaveric model with an intact rib cage. METHODS Seven human thoracic cadavers with intact rib cages were loaded with pure moments in flexion, extension, axial rotation, and lateral bending for five conditions: intact, PO at T9-T10, PO at T8-T9, PO at T7-T8, and PO at T6-T7. Motion of T1, T6, and T10 were measured, and overall (T1-T12) and regional (T6-T10) ROMs were reported for each mode of bending at each condition. RESULTS POs increased ROM in flexion both overall (T1-T12) and regionally (T6-T10), although the magnitude of the increase was marginal (<1°/PO). No significant differences were found in axial rotation or lateral bending. CONCLUSIONS POs may increase sagittal correction potential before fusion in patients with hyperkyphosis, though more work should be done to determine the magnitude of the changes. LEVEL OF EVIDENCE Level V.
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14
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Wang X, Boyer L, Le Naveaux F, Schwend RM, Aubin CE. How does differential rod contouring contribute to 3-dimensional correction and affect the bone-screw forces in adolescent idiopathic scoliosis instrumentation? Clin Biomech (Bristol, Avon) 2016; 39:115-121. [PMID: 27750078 DOI: 10.1016/j.clinbiomech.2016.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/25/2016] [Accepted: 10/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Differential rod contouring is used to achieve 3-dimensional correction in adolescent idiopathic scoliosis instrumentations. How vertebral rotation correction is correlated with the amount of differential rod contouring is still unknown; too aggressive differential rod contouring may increase the risk of bone-screw connection failure. The objective was to assess the 3-dimensional correction and bone-screw forces using various configurations of differential rod contouring. METHODS Computerized patient-specific biomechanical models of 10 AIS cases were used to simulate AIS instrumentations using various configurations of differential rod contouring. The tested concave/convex rod configurations were 5.5/5.5 and 6.0/5.5mm diameter Cobalt-chrome rods with contouring angles of 35°/15°, 55°/15°, 75°/15°, and 85°/15°, respectively. 3-dimensional corrections and bone-screw forces were computed and analyzed. FINDINGS Increasing the difference between the concave and convex rod contouring angles from 25° to 60°, the apical vertebral rotation correction increased from 35% (SD 17%) to 68% (SD 24%), the coronal plane correction changed from 76% (SD 10%) to 72% (SD 12%), the thoracic kyphosis creation from 27% (SD 60%) to 144% (SD 132%), and screw pullout forces from 94N (SD 68N) to 252N (SD 159N). Increasing the concave rod diameter to 6mm resulted in increased transverse and coronal plane corrections, higher thoracic kyphosis, and screw pullout forces. INTERPRETATIONS Increasing the concave rod contouring angle and diameter with respect to the convex rod improved the transverse plane correction but with significant increase of screw pullout forces and thoracic kyphosis. Rod contouring should be planned by also taking into account the 3-dimensional nature and stiffness of the curves and combined with osteotomy procedures, which remains to be studied.
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Affiliation(s)
- Xiaoyu Wang
- Polytechnique Montréal, Department of Mechanical Engineering, P.O. Box 6079, Downtown Station, Montreal (Quebec), H3C 3A7, Canada; Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal (Quebec), H3T 1C5, Canada
| | - Laure Boyer
- Polytechnique Montréal, Department of Mechanical Engineering, P.O. Box 6079, Downtown Station, Montreal (Quebec), H3C 3A7, Canada; Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal (Quebec), H3T 1C5, Canada
| | - Franck Le Naveaux
- Polytechnique Montréal, Department of Mechanical Engineering, P.O. Box 6079, Downtown Station, Montreal (Quebec), H3C 3A7, Canada; Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal (Quebec), H3T 1C5, Canada
| | - Richard M Schwend
- Children's Mercy Hospital, 2401, Gillham Rd, Kansas City, (Missouri) 64108, USA
| | - Carl-Eric Aubin
- Polytechnique Montréal, Department of Mechanical Engineering, P.O. Box 6079, Downtown Station, Montreal (Quebec), H3C 3A7, Canada; Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal (Quebec), H3T 1C5, Canada.
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15
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Holewijn RM, Schlösser TPC, Bisschop A, van der Veen AJ, Stadhouder A, van Royen BJ, Castelein RM, de Kleuver M. How Does Spinal Release and Ponte Osteotomy Improve Spinal Flexibility? The Law of Diminishing Returns. Spine Deform 2015; 3:489-495. [PMID: 27927536 DOI: 10.1016/j.jspd.2015.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 02/12/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
STUDY DESIGN Experimental study. OBJECTIVES To evaluate the effect of stepwise resection of posterior spinal ligaments, facet joints, and ribs on thoracic spinal flexibility. SUMMARY OF BACKGROUND DATA Posterior spinal ligaments, facet joints and ribs are removed to increase spinal flexibility in corrective spinal surgery for deformities such as adolescent idiopathic scoliosis (AIS). Reported clinical results vary and biomechanical substantiation is lacking. METHODS Ten fresh-frozen human cadaveric thoracic spinal specimens (T6-T11) were studied. A spinal motion simulator applied a pure moment of ±2.5 Nm in flexion, extension, lateral bending (LB) and axial rotation (AR). Range of motion (ROM) was measured for the intact spine and measured again after stepwise resection of the supra/interspinous ligament (SIL), inferior facet, flaval ligament, superior facet, and rib heads. RESULTS SIL resection increased ROM in flexion (10.2%) and AR (3.1%). Successive inferior facetectomy increased ROM in flexion (4.1%), LB (3.8%) and AR (7.7%), and flavectomy in flexion (9.1%) and AR (2.5%). Sequential superior facetectomy only increased ROM in flexion (6.3%). Rib removal provided an additional increase in flexion (6.3%), LB (4.5%) and AR (13.0%). Extension ROM increased by 10.5% after the combined removal of the SIL, inferior facet and flaval ligament. CONCLUSIONS Posterior spinal releases in these non-scoliotic spines led to an incremental increase in spinal flexibility, but each sequential step had less effect. As compared to SIL resection with inferior facetectomy, additional superior facetectomy did not improve flexibility in AR and LB and only 6.3% in flexion. The data presented from this in vitro study should be interpreted with care, as no representative cadaveric spine model for AIS was available, However, the results presented here at least question the benefits of performing routine complete facetectomies (i.e. Ponte osteotomies) to increase spinal flexibility in scoliosis surgery.
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Affiliation(s)
- Roderick M Holewijn
- Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Tom P C Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Arno Bisschop
- Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Albert J van der Veen
- Department of Physics and Medical Technology, VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Agnita Stadhouder
- Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Barend J van Royen
- Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Marinus de Kleuver
- Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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16
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Do Ponte Osteotomies Enhance Correction in Adolescent Idiopathic Scoliosis? An Analysis of 191 Lenke 1A and 1B Curves. Spine Deform 2015; 3:483-488. [PMID: 27927535 DOI: 10.1016/j.jspd.2015.03.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 02/19/2015] [Accepted: 03/02/2015] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN Retrospective review of a prospectively collected multicenter database of patients with adolescent idiopathic scoliosis (AIS). OBJECTIVE To determine if Ponte osteotomies improve correction in Lenke 1A and 1B AIS curves treated with pedicle screws. SUMMARY OF BACKGROUND DATA There is little data studying the risks and benefits of Ponte osteotomies in AIS. METHODS We identified patients with Lenke 1A and 1B curve types treated with pedicle screw constructs and a 2-year follow-up. They were grouped based on whether they did (PO) or did not (NoPO) have Ponte osteotomies. Demographic, surgical, and radiographic data collected preoperatively and at 2 years were statistically analyzed using unpaired Student t test and Fisher exact test. RESULTS One hundred ninety-one patients met the inclusion criteria (mean age of 14.7 ± 2.2 years), and among those, 125 patients (65.4%) had Ponte osteotomies (average of 4.3 ± 1.5 Pontes per patient). The patients treated with Ponte osteotomies had similar clinical and radiographic parameters (major Cobb: PO = 51.5°, NoPO = 50.8°, p = .6) to the patients who did not have Ponte osteotomies except that they had stiffer and more lordotic curves (Flexibility Index: PO = 47.3%, NoPO = 54.5%, p = .04; T5-T12 kyphosis: PO = 18.7°, NoPO = 23.2°, p = .02). At 2 years, the patients treated with Ponte osteotomies had significantly better thoracic Cobb angle correction (Correction Index: PO = 67.1%, NoPO = 61.8%, p = .01) and an increase in T5-T12 kyphosis (PO = +3.0°, NoPO = -0.4°, p = .045). The Ponte group demonstrated greater rib prominence correction (PO = 53.2%, NoPO = 38.4%, p = .02). There were no neurologic events in this cohort. CONCLUSIONS Although the use of Ponte osteotomies was not randomized, these data suggest that greater deformity correction in all 3 planes may be possible when Ponte osteotomies are performed for the stiffer and more lordotic Lenke 1A and 1B curves. The clinical significance of these overall small statistical differences remains to be determined. LEVEL OF EVIDENCE III.
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17
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Lee IS, Lee T, Shin WC, Wallraven C, Lee H, Park HJ, Lee H, Chae Y. Haptic Simulation for Acupuncture Needle Manipulation. J Altern Complement Med 2014; 20:654-60. [DOI: 10.1089/acm.2013.0475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- In-Seon Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Taehyung Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Woo-Chul Shin
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Christian Wallraven
- Department of Brain Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Hyangsook Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hi-Joon Park
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Hyejung Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Brain Cognitive Engineering, Korea University, Seoul, Republic of Korea
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18
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Sangiorgio SN, Borkowski SL, Bowen RE, Scaduto AA, Frost NL, Ebramzadeh E. Quantification of Increase in Three-dimensional Spine Flexibility Following Sequential Ponte Osteotomies in a Cadaveric Model. Spine Deform 2013; 1:171-178. [PMID: 27927289 DOI: 10.1016/j.jspd.2013.01.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 01/09/2013] [Accepted: 01/13/2013] [Indexed: 11/30/2022]
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 T7-T12, 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-T11) 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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Affiliation(s)
- Sophia N Sangiorgio
- Orthopaedic Biomechanics and Mechanobiology Lab, Santa Monica UCLA Medical Center and Orthopaedic Hospital, 1250 Sixteenth St, Suite 2260, Santa Monica, CA 90404.
| | - Sean L Borkowski
- Orthopaedic Biomechanics and Mechanobiology Lab, Santa Monica UCLA Medical Center and Orthopaedic Hospital, 1250 Sixteenth St, Suite 2260, Santa Monica, CA 90404; UCLA Bioengineering/Biomedical Engineering IDP, University of California Los Angeles, 5121 Engineering V, Los Angeles, CA 90095
| | - Richard E Bowen
- Los Angeles Orthopaedic Hospital and UCLA Department of Orthopaedic Surgery, 1250 Sixteenth St, Santa Monica, CA 90404, USA
| | - Anthony A Scaduto
- Los Angeles Orthopaedic Hospital and UCLA Department of Orthopaedic Surgery, 1250 Sixteenth St, Santa Monica, CA 90404, USA
| | - Nathan L Frost
- Orthopaedic Biomechanics and Mechanobiology Lab, Santa Monica UCLA Medical Center and Orthopaedic Hospital, 1250 Sixteenth St, Suite 2260, Santa Monica, CA 90404; Los Angeles Orthopaedic Hospital and UCLA Department of Orthopaedic Surgery, 1250 Sixteenth St, Santa Monica, CA 90404, USA
| | - Edward Ebramzadeh
- Orthopaedic Biomechanics and Mechanobiology Lab, Santa Monica UCLA Medical Center and Orthopaedic Hospital, 1250 Sixteenth St, Suite 2260, Santa Monica, CA 90404
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Papadimitriou K, Amin AG, Kretzer RM, Chaput C, Tortolani PJ, Wolinsky JP, Gokaslan ZL, Baaj AA. The rib head as a landmark in the anterolateral approach to the thoracic spine: a computed tomography-based morphometric study. J Neurosurg Spine 2013; 18:484-9. [PMID: 23452247 DOI: 10.3171/2013.1.spine12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The rib head is an important landmark in the anterolateral approach to the thoracic spine. Resection of the rib head is typically the first step in gaining access to the underlying pedicle and ultimately the spinal canal. The goal of this work is to quantify the relationship of the rib head to the spinal canal and adjacent aorta at each thoracic level using CT-based morphometric measurements. METHODS One hundred thoracic spine CT scans (obtained in 50 male and 50 female subjects) were evaluated in this study. The width and depth of each vertebra body were measured from T-1 to T-12. In addition, the distance of each rib head to the spinal canal was determined by drawing a line connecting the rib heads bilaterally and measuring the distance to this line from the most ventral aspect of the spinal canal. Finally, the distance of the left rib head to the thoracic aorta was measured at each thoracic level below the aortic arch. RESULTS The vertebral body depth progressively increased in a rostral to caudal direction. The vertebral body width was at its minimum at T-4 and progressively increased to T-12. The rib head extended beyond the spinal canal maximally at T-1. This distance incrementally decreased toward the caudal levels, with the tip of the rib head lying approximately even with the ventral canal at T-11 and T-12. The distance between the aorta and the left rib head increased in a rostral to caudal direction as well. CONCLUSIONS The rib head is an important landmark in the anterolateral approach to the thoracic spine. At more cephalad levels, a larger portion of rib head requires resection to gain access to the spinal canal. At more caudad levels, there is a safer working distance between the rib head and aorta.
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Affiliation(s)
- Kyriakos Papadimitriou
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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