Effects of Ponte Osteotomy on Vertebral Rotation in Idiopathic Scoliosis: A Scoping Review

Ponte osteotomy (PO) is frequently used in corrective surgery, yet its specific effect on vertebral rotation correction remains unclear. This study systematically reviewed the literature to compare PO with alternative techniques in patients with idiopathic scoliosis. Following PRISMA methodology, MEDLINE, Embase, and Web of Science were searched for comparative studies assessing axial rotation outcomes in idiopathic scoliosis treated with or without PO. The primary outcome was vertebral rotation correction.

Six studies were included, encompassing a total of 439 patients with mean ages ranging from 13.5 ± 2.8 to 17.5 ± 3.7 years. Most study populations were predominantly female in four studies, predominantly male in one, and evenly distributed in one. Two studies showed a meaningful improvement in postoperative thoracic rotation in the PO group compared to inferior facetectomy (IF). Other studies found PO to be superior to IF and posterior spinal fusion (PSF), although these differences were not statistically significant, except for one study that reported a statistically significant advantage of PO over PSF. No meaningful superiority was observed when comparing PO with skip pedicle screw fixation. Overall, intraoperative and postoperative complication rates were similar between PO and non-PO groups, although one study reported a higher rate of intraoperative neuromonitoring changes and reoperations in the PO group. Most studies to date have found that PO is associated with superior vertebral rotation outcomes compared to IF and PSF, with only half showing statistical significance. PO is also linked to longer operative time and greater blood loss, warranting further high-quality studies to clarify its risk-benefit profile.