Novel posterior column osteotomy technique may improve deformity correction in scoliosis

Key takeaways:

• The novel osteotomy and Ponte osteotomy groups had a slight increase in blood loss and surgical time vs. the no osteotomy group.
• The novel osteotomy group had greater deformity correction vs. the other groups.

Results showed a novel posterior column osteotomy technique may be effective in improving deformity correction in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion.

“The new osteotomy that we are doing is as or more effective than the traditional Ponte osteotomy,” Alec C. Stall, MD, vice chair of the department of orthopedics at Nemours Children’s Hospital, Florida, and associate professor of orthopedics at the University of Central Florida College of Medicine, told Healio about results presented at the Combined EPOSNA Meeting. “Whereas the Ponte osteotomy was designed to address kyphosis by shortening the posterior column, our osteotomy is designed to detether and lengthen the posterior column, which is often necessary when attempting to restore the sagittal alignment in scoliosis surgery. Because no bone is removed, exposure of the spinal canal is minimized.”

Stall and colleagues retrospectively reviewed data for 151 patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion with standard Ponte osteotomy, a novel posterior column osteotomy or without osteotomy. According to the abstract, all patients had progressive curves of greater than 50° at the time of surgery.

“In terms of safety, there was no difference in terms of risk of neurologic events,” Stall said. “Neurologic events, fortunately, are rare and the study was not powered sufficiently to look at that outcome fully. There were a total of three neuromonitoring events between the three groups with one event in the no osteotomy group and two in the Ponte osteotomy group. There were no neurologic deficits in any of the groups.”

The Ponte osteotomy group and the novel posterior column osteotomy group had a slight increase in blood loss and surgical time compared with the no osteotomy group, according to Stall. However, he said the result was clinically irrelevant.

“You are talking about a few milliliters of increased blood loss and 15 minutes of surgical time. These differences were statistically significant, but I would argue not clinically significant,” Stall said.

Stall said the novel posterior column osteotomy group had statistically and clinically greater deformity correction compared with the no osteotomy group and statistically greater deformity correction vs. the Ponte osteotomy group.

“Again, that falls into a category of statistically significant, but I do not think clinically significant,” Stall said. “We had a 3° increase in correction with our osteotomy than with the Ponte osteotomy, which I believe most surgeons would argue is not a clinically significant difference since it falls with the error of Cobb angle measurement.”

Alec C. Stall, MD, of Nemours Children’s Hospital, Florida, can be reached at leah.goodwyne@nemours.org.