title: Ponte osteotomies to treat major thoracic adolescent idiopathic scoliosis curves allow more effective corrective maneuvers.
abstract: OBJECTIVE
  There is controversy regarding the effect of the Ponte osteotomies in the improvement of coronal correction, its maintenance during follow-up, and the restoration of thoracic kyphosis in adolescent idiopathic scoliosis (AIS).
  
  
  METHODS
  Seventy-three AIS patients with Lenke type 1-4 curves were included. A prospective description of 43 consecutive patients who underwent apical Ponte osteotomies and sublaminar wires with hybrid instrumentation was retrospectively compared to a historical cohort of 30 patients without "Ponte osteotomies". The surgical details and complications were recorded. We evaluated the radiological measurements and SRS-22 Questionnaire scores over a 2-year follow-up.
  
  
  RESULTS
  The Ponte group achieved better postoperative (70 vs 57 %) and final (62 vs 50 %) main curve correction P < 0.001, with no significant loss of correction (4.2° vs 2.5°) P = 0.2 at the final follow-up (48 vs 106 months). We did not find a difference in thoracic (T5-T12) postoperative (22° vs 24°) and final (25° vs 26°) mean kyphosis angle. However, the "Ponte osteotomies" helped to achieve a normal sagittal profile, increasing preoperative hypokyphotic curves (<10°) from 6° to 17° (control: 9°-12°; P = 0.01); and preoperative hyperkyphotic curves (>40°) from 52° to 26° (control: 46°-39°; P = 0.01). The length of surgery was similar (4.3 vs 4.6 h), as were the SRS-22 scores. No major complications were found.
  
  
  CONCLUSIONS
  Ponte osteotomies in major thoracic AIS curves treated by sublaminar wires allowed more effective corrective maneuvers, which improved coronal correction without a significant loss during follow-up. The sagittal profile appears to be determined by other variables; however, "Ponte osteotomies" facilitate the contouring of the desired kyphosis.
authors.affiliation: Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario de Getafe, Carretera de Toledo Km. 12.5, 28905, Getafe, Madrid, Spain, javierpizones@gmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Pizones
authors.forename: Felisa
authors.initials: F
authors.lastname: Sánchez-Mariscal
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Zúñiga
authors.forename: Enrique
authors.initials: E
authors.lastname: Izquierdo
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D001864:Bone Wires; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome