Biomechanical analysis of Ponte and pedicle subtraction osteotomies for the surgical correction of kyphotic deformities.

Abstract

Biomechanical analysis of Ponte (PO) and pedicle subtraction osteotomies (PSO) in kyphotic deformity instrumentation. Patient-specific biomechanical model was used to computationally simulate seven hyperkyphotic instrumentation cases with three osteotomy strategies-1-level PSO, 3-level PO, or 6-level PO; forces within the instrumented spine were assessed and results were analyzed through rANOVA tests. Corrections with multi-level PO were close to those with one-level PSO. In upright position, average implant forces were from 225 to 280 N and rod bending moments were around 10 Nm with no significant difference between the three strategies (p < 0.05). In simulations of 30° flexion, rod bending moments increased by 38, 2, and 8 %, implant forces increased by 28, 23 and 26 % for the 1-level PSO, 3-level PO, and 6-level PO, respectively. Correction per vertebral level was smaller than the maximum correction allowed by PO and PSO. Multi-level PO allows similar kyphotic correction to 1-level PSO in spinal deformities with mixed indications for PO and PSO. Loads on the instrumentation constructs in PSO were higher than multi-level PO and higher in 6-level PO than 3-level PO. High loads were located more on the osteotomy sites. The rod shape should be adapted to the anticipated spine correction on the osteotomy sites.