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Multiple Ponte osteotomies with low implant density: Is it enough for correction of Scheuermann's kyphosis?
Ahmed Adel Abdelazim Kamel Elnagar1, Youssry Mohamed Kamal Elhawary1, Yasser Hassan Samir Elmeligy1
1Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
Context:
Posterior-only pedicle screw fixation is now the leading surgical treatment for Scheuermann's kyphosis (SK). However, high-density screw constructs increase the risk of malpositioning complications and elevate overall surgical costs.
Aims:
To evaluate the safety and clinical efficacy of the low screw density (LSD) technique combined with multiple Ponte osteotomies for the correction of SK.
Settings And Design:
This prospective case series was conducted at Kasr Al-Aini and Al-Salam International Hospitals.
Subjects And Methods:
This study was conducted between December 2020 and December 2022 and enrolled 30 patients who underwent posterior-only correction using the LSD approach and multilevel Ponte osteotomies.
Results:
The cohort (mean age 20.5 years; range 13-37) presented with a mean preoperative maximum kyphosis of 85.9° (range 75°-108°) and a mean pelvic incidence-lumbar lordosis (PI-LL) mismatch of 25.9°. Following surgery, the mean maximum kyphosis improved to 46.2° (range 37°-63°), and the PI-LL mismatch was reduced to 7.7°. These corrections remained stable at the 1- and 2-year follow-ups, with no statistically significant loss of sagittal alignment.
Conclusions:
The LSD technique, supported by multiple Ponte osteotomies, is a safe and effective surgical strategy for correcting SK, providing stable deformity correction with reduced instrumentation.
