title: Do Ponte Osteotomies Enhance Correction in Adolescent Idiopathic Scoliosis? An Analysis of 191 Lenke 1A and 1B Curves.
abstract: METHODS
  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.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  III.
authors.affiliation: Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA. Electronic address: amersamdani@gmail.com.
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
authors.affiliation: Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Bennett
authors.affiliation: University of Virginia Medical Center, Charlottesville, VA, USA.
authors.forename: Anuj R
authors.initials: AR
authors.lastname: Singla
authors.affiliation: Setting Scoliosis Straight Foundation, San Diego, CA, USA.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Marks
authors.affiliation: Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Pahys
authors.affiliation: NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Baron S
authors.initials: BS
authors.lastname: Lonner
authors.affiliation: BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Firoz
authors.initials: F
authors.lastname: Miyanji
authors.affiliation: Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
authors.forename: Suken A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Miami Children's Hospital, Miami, FL, USA.
authors.forename: Harry L
authors.initials: HL
authors.lastname: Shufflebarger
authors.affiliation: Rady Children's Hospital, San Diego, CA, USA.
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
authors.affiliation: Miami Children's Hospital, Miami, FL, USA.
authors.forename: Jahangir
authors.initials: J
authors.lastname: Asghar
authors.affiliation: Institute for Spine and Scoliosis, Lawrenceville, NJ, USA.
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Cahill
keywords: AIS; Lenke 1; Pedicle screw; Ponte osteotomy; Scoliosis