title: Quantification of Increase in Three-dimensional Spine Flexibility Following Sequential Ponte Osteotomies in a Cadaveric Model.
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.
authors.affiliation: Orthopaedic Biomechanics and Mechanobiology Lab, Santa Monica UCLA Medical Center and Orthopaedic Hospital, 1250 Sixteenth St, Suite 2260, Santa Monica, CA 90404. Electronic address: sophia.biomechanics@gmail.com.
authors.forename: Sophia N
authors.initials: SN
authors.lastname: Sangiorgio
authors.affiliation: 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.
authors.forename: Sean L
authors.initials: SL
authors.lastname: Borkowski
authors.affiliation: Los Angeles Orthopaedic Hospital and UCLA Department of Orthopaedic Surgery, 1250 Sixteenth St, Santa Monica, CA 90404, USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Bowen
authors.affiliation: Los Angeles Orthopaedic Hospital and UCLA Department of Orthopaedic Surgery, 1250 Sixteenth St, Santa Monica, CA 90404, USA.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Scaduto
authors.affiliation: 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.
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Frost
authors.affiliation: Orthopaedic Biomechanics and Mechanobiology Lab, Santa Monica UCLA Medical Center and Orthopaedic Hospital, 1250 Sixteenth St, Suite 2260, Santa Monica, CA 90404.
authors.forename: Edward
authors.initials: E
authors.lastname: Ebramzadeh
keywords: Biomechanics; Cadaver model; Deformity correction; Scoliosis; Sequential destabilization; Spine