title: Biomechanical analysis of Ponte and pedicle subtraction osteotomies for the surgical correction of kyphotic deformities.
abstract: Biomechanical analysis of Ponte (PO) and pedicle subtraction osteotomies (PSO) in kyphotic deformity instrumentation.
  
  
  
  Patient-specific biomechanical model was used to computationally simulate seven hyperkyphotic instrumentation cases with three osteotomy strategies-1-level PSO, 3-level PO, or 6-level PO; forces within the instrumented spine were assessed and results were analyzed through rANOVA tests.
  
  
  
  Corrections with multi-level PO were close to those with one-level PSO. In upright position, average implant forces were from 225 to 280 N and rod bending moments were around 10 Nm with no significant difference between the three strategies (p < 0.05). In simulations of 30° flexion, rod bending moments increased by 38, 2, and 8 %, implant forces increased by 28, 23 and 26 % for the 1-level PSO, 3-level PO, and 6-level PO, respectively. Correction per vertebral level was smaller than the maximum correction allowed by PO and PSO.
  
  
  
  Multi-level PO allows similar kyphotic correction to 1-level PSO in spinal deformities with mixed indications for PO and PSO. Loads on the instrumentation constructs in PSO were higher than multi-level PO and higher in 6-level PO than 3-level PO. High loads were located more on the osteotomy sites. The rod shape should be adapted to the anticipated spine correction on the osteotomy sites.
authors.affiliation: Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada.|Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada.
authors.forename: Giuditta
authors.initials: G
authors.lastname: Salvi
authors.affiliation: Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada. carl-eric.aubin@polymtl.ca.|Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada. carl-eric.aubin@polymtl.ca.
authors.forename: Carl-Eric
authors.initials: CE
authors.lastname: Aubin
authors.affiliation: Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada.|Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada.
authors.forename: Franck
authors.initials: F
authors.lastname: Le Naveaux
authors.affiliation: Department of Mechanical Engineering, Polytechnique Montreal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada.|Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Wang
authors.affiliation: Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada.
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D002648:Child; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000601:surgery; D008297:Male; D010027:Osteotomy / Q000379:methods*; D012544:Scheuermann Disease / Q000601:surgery*; D013131:Spine / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Biomechanical modeling; Kyphosis; Pedicle subtraction osteotomy; Ponte osteotomy; Scheuermann’s disease; Spinal instrumentation