RESTORATION OF THORACIC KYPHOSIS WITH MULTILEVEL Ponte OSTEOTOMIES IN THORACIC IDIOPATHIC SCOLIOSIS SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Guoying , ZHANG Yonggang , ZHANG Xuesong , WANG Zheng , MAO Keya , WANG Yan.

Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China. Corresponding author: ZHANG Yonggang, E-mail: zhangyg301@hotmail.com;

Corresponding author：

Keywords：

Idiopathic scoliosis; Osteotomy; Thoracic kyphosis

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Objective To investigate the effectiveness of multilevel Ponte osteotomies on maintenance and restoration of thoracic kyphosis in idiopathic scoliosis (IS) surgery. Methods Between March 2008 and February 2010, 42 patients with thoracic IS (Lenke type 1 curves) were corrected with posterior pedicle screw system. Multilevel Ponte osteostomies for posterior release was performed in 17 cases (group A), and the 3 segments near the apical vertebrae were selected as the osteotomy site; simple posterior soft tissue release was given in 25 cases (group B). There was no significant difference in sex, age, disease duration, lesion segments, coronary Cobb angle, thoracic kyphosis, Risser index, and bending flexibility between 2 groups (P gt; 0.05). The anteroposterior and lateral standing radiographs of the spine were taken to compare the effectiveness between 2 groups. Results Operation was successfully completed in all patients. The operation time and blood loss in group A were significantly greater than those in group B (P lt; 0.05). Spine dural injury and leakage of cerebrospinal fluid occurred in 1 case of group A, which was cured after compression on local area of the wound; the other patients had no intraoperative complications. The patients were followed up 2-4 years (mean, 2.8 years); no nerve injury, infection, or internal fixation failure occurred. No obvious correction loss was observed and the appearance and trunk balance were significantly improved. The coronal Cobb angles at 1 week and 2 years after operation were significantly improved when compared with preoperative ones in 2 groups (P lt; 0.05). There was no significant difference in the coronal Cobb angle and correction rate between 2 groups at 1 week and 2 years after operation (P gt; 0.05). Group A was significantly better than group B in the thoracic kyphotic angle and angle changes at 1 week and 2 years after operation (P lt; 0.05). Conclusion The posterior approach surgery with multilevel Ponte osteotomies can restore the thoracic kyphosis in IS, but it has no effect on coronal correction in Lenke type 1 curves.

Citation： ZHANG Guoying,ZHANG Yonggang,ZHANG Xuesong,WANG Zheng,MAO Keya,WANG Yan.. RESTORATION OF THORACIC KYPHOSIS WITH MULTILEVEL Ponte OSTEOTOMIES IN THORACIC IDIOPATHIC SCOLIOSIS SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(10): 1197-1201. doi: Copy

1.	Hayashi K, Upasani VV, Pawelek JB, et al. Three-dimensional analysis of thoracic sagittal alignment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2009, 34(8): 792-797.
2.	Newton PO, Faro FD, Gollogly S, et al. Results of preoperati ve Pulmonary function testing of adolescents with idiopathic scoliosis: a study of six hundred and thirty-one patients. J Bone Joint Surg (Am), 2005, 87(9): 1937-1946.
3.	Newton PO, Yaszay B, Upasani VV, et al. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2010, 35(14): 1365-1370.
4.	Graham EJ, Lenkc LG, Lowe TG, et al. Prospective pulmonary function evaluation following open thoracotomy for anterior spinal fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2000, 25(18): 2319-2325.
5.	Newton PO, Marks M, Faro F, et al. Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery. Spine (Phila Pa 1976), 2003, 28(20): S249-S254.
6.	Faro FD, Marks MC, Newton PO, et al. Perioperative changes in pulmonary function after anterior scoliosis instrumentation: thoracoscopic versus open approaches. Spine (Phila Pa 1976), 2005, 30(9): 1058-1063.
7.	Imrie M, Yaszay B, Bastrom TP, et al. Adolescent idiopathic scoliosis: should 100% correction be the goal? J Pediatr Orthop, 2011, 31(1 Suppl): S9-13.
8.	Suk SI, Kim WJ, Kim JH, et al. Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between multiple-hook and segmental pedicle screw fixation in adolescent idiopathic scoliosis. J Spinal Disord, 1999, 12(6): 489-495.
9.	Suk SI, Lee SM, Chung ER, et al. Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine (Phila Pa 1976), 2003, 28(5): 484-491.
10.	Kim YJ, Lenke LG, Kim J, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2006, 31(3): 291-298.
11.	Lowenstein JE, Matsumoto H, Vitale MG, et al. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976), 2007, 32(4): 448-452.
12.	Clement JL, Chau E, Kimkpe C, et al. Restoration of thoracic kyphosis by posterior instrumentation in adolescent idiopathic scoliosis: comparative radiographic analysis of two methods of reduction. Spine (Phila Pa 1976), 2008, 33(14): 1579-1587.
13.	Mladenov KV, Vaeterlein C, Stuecker R. Selective posterior thoracic fusion by means of direct vertebral derotation in adolescent idiopathic scoliosis: effects on the sagittal alignment. Eur Spine J, 2011, 20(7): 1114-1117.
14.	Qiu Y, Zhu F, Wang B, et al. Comparison of surgical outcomes of lenke type 1 idiopathic scoliosis: vertebral coplanar alignment versus derotation technique. J Spinal Disord Tech, 2011, 24(8): 492-499.
15.	Geck MJ, Macagno A, Ponte A, et al. The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech, 2007, 20(8): 586-593.
16.	Shufflebarger HL, Clark CE. Effect of wide posterior release on correction in adolescent idiopathic scoliosis. J Pediatr Orthop B, 1998, 7(2): 117-123.
17.	Shufflebarger HL, Geck MJ, Clark CE. The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine (Phila Pa 1976), 2004, 29(3): 269-276.
18.	Halanski MA, Cassidy JA. Do multilevel ponte osteotomies in thoracic idiopathic scoliosis surgery improve curve correction and restore thoracic kyphosis? J Spinal Disord Tech, 2011. [Epub ahead of print].
19.	Fletcher ND, Hopkins J, McClung A, et al. Residual thoracic hypokyphosis following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis: risk factors and clinical ramifications. Spine (Phila Pa 1976), 2012, 37(3): 200-206.
20.	Suk SI. Pedicle screw instrumentation for adolescent idiopathic scoliosis: the insertion technique, the fusion levels and direct vertebral rotation. Clin Orthop Surg, 2011, 3(2): 89-100.

1. Hayashi K, Upasani VV, Pawelek JB, et al. Three-dimensional analysis of thoracic sagittal alignment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2009, 34(8): 792-797.
2. Newton PO, Faro FD, Gollogly S, et al. Results of preoperati ve Pulmonary function testing of adolescents with idiopathic scoliosis: a study of six hundred and thirty-one patients. J Bone Joint Surg (Am), 2005, 87(9): 1937-1946.
3. Newton PO, Yaszay B, Upasani VV, et al. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2010, 35(14): 1365-1370.
4. Graham EJ, Lenkc LG, Lowe TG, et al. Prospective pulmonary function evaluation following open thoracotomy for anterior spinal fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2000, 25(18): 2319-2325.
5. Newton PO, Marks M, Faro F, et al. Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery. Spine (Phila Pa 1976), 2003, 28(20): S249-S254.
6. Faro FD, Marks MC, Newton PO, et al. Perioperative changes in pulmonary function after anterior scoliosis instrumentation: thoracoscopic versus open approaches. Spine (Phila Pa 1976), 2005, 30(9): 1058-1063.
7. Imrie M, Yaszay B, Bastrom TP, et al. Adolescent idiopathic scoliosis: should 100% correction be the goal? J Pediatr Orthop, 2011, 31(1 Suppl): S9-13.
8. Suk SI, Kim WJ, Kim JH, et al. Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between multiple-hook and segmental pedicle screw fixation in adolescent idiopathic scoliosis. J Spinal Disord, 1999, 12(6): 489-495.
9. Suk SI, Lee SM, Chung ER, et al. Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine (Phila Pa 1976), 2003, 28(5): 484-491.
10. Kim YJ, Lenke LG, Kim J, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2006, 31(3): 291-298.
11. Lowenstein JE, Matsumoto H, Vitale MG, et al. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976), 2007, 32(4): 448-452.
12. Clement JL, Chau E, Kimkpe C, et al. Restoration of thoracic kyphosis by posterior instrumentation in adolescent idiopathic scoliosis: comparative radiographic analysis of two methods of reduction. Spine (Phila Pa 1976), 2008, 33(14): 1579-1587.
13. Mladenov KV, Vaeterlein C, Stuecker R. Selective posterior thoracic fusion by means of direct vertebral derotation in adolescent idiopathic scoliosis: effects on the sagittal alignment. Eur Spine J, 2011, 20(7): 1114-1117.
14. Qiu Y, Zhu F, Wang B, et al. Comparison of surgical outcomes of lenke type 1 idiopathic scoliosis: vertebral coplanar alignment versus derotation technique. J Spinal Disord Tech, 2011, 24(8): 492-499.
15. Geck MJ, Macagno A, Ponte A, et al. The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech, 2007, 20(8): 586-593.
16. Shufflebarger HL, Clark CE. Effect of wide posterior release on correction in adolescent idiopathic scoliosis. J Pediatr Orthop B, 1998, 7(2): 117-123.
17. Shufflebarger HL, Geck MJ, Clark CE. The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine (Phila Pa 1976), 2004, 29(3): 269-276.
18. Halanski MA, Cassidy JA. Do multilevel ponte osteotomies in thoracic idiopathic scoliosis surgery improve curve correction and restore thoracic kyphosis? J Spinal Disord Tech, 2011. [Epub ahead of print].
19. Fletcher ND, Hopkins J, McClung A, et al. Residual thoracic hypokyphosis following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis: risk factors and clinical ramifications. Spine (Phila Pa 1976), 2012, 37(3): 200-206.
20. Suk SI. Pedicle screw instrumentation for adolescent idiopathic scoliosis: the insertion technique, the fusion levels and direct vertebral rotation. Clin Orthop Surg, 2011, 3(2): 89-100.

Chinese Journal of Reparative and Reconstructive Surgery

RESTORATION OF THORACIC KYPHOSIS WITH MULTILEVEL Ponte OSTEOTOMIES IN THORACIC IDIOPATHIC SCOLIOSIS SURGERY

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