Ponte Osteotomy

Ponte osteotomies are used where a gradual, multi-level correction is wanted, particularly for kyphosis and to add correction and flexibility in scoliosis surgery. They work best where the discs are still reasonably mobile, because the correction hinges partly through the disc space. By spreading the correction across several levels, they produce a smooth, harmonious result rather than a sharp change at a single point, and they can be combined with instrumented fusion for a lasting correction.

The osteotomy is performed from the back. At each chosen level, the facet joints and the ligament between the bony arches are removed, opening the posterior column so that the spine can be compressed and hinged into a more balanced shape. Pedicle screws and rods are used to apply and hold the correction across the treated levels, and bone graft is added so the segments fuse. Because several levels are addressed with a modest correction at each, the technique gives controlled, distributed correction, and the spinal cord and nerves are protected with careful technique and monitoring.

The evidence supports Ponte osteotomies as an effective way to correct kyphosis and to enhance correction in deformity surgery. Series of posterior-only correction of Scheuermann's kyphosis using segmental posterior shortening and pedicle screws report good, durable results, and studies examine how much correction each osteotomy contributes and how the technique is best performed and made safe. The literature also notes that not all Ponte osteotomies are equal, and that technique and level selection matter. The balanced view is that the Ponte osteotomy is a versatile, well-evidenced tool for multi-level correction, particularly of kyphosis.

The procedure is carried out under general anaesthetic as part of a deformity correction, usually with a hospital stay of several days and a recovery measured in months, supported by rehabilitation. The correction is achieved during surgery and held by the metalwork while the treated levels fuse over the following months. As with any deformity surgery there are risks, which are discussed fully beforehand, and whether Ponte osteotomies are the right part of a correction plan is decided together.

• —Geck MJ, et al. The Ponte procedure: posterior-only treatment of Scheuermann kyphosis using segmental posterior shortening and pedicle screws. J Spinal Disord Tech 2007. (PMID 18046172)
• —Shufflebarger HL, et al. Posterior approach for adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine 2004. (PMID 14752348)
• —Nasto LA, et al. Ponte osteotomies for the treatment of spinal deformities: they are not all made equal. Eur Spine J 2024. (PMID 38822151)
• —Hollyer I, et al. A novel sequential approach to the Ponte osteotomy to minimise spinal canal exposure. Children (Basel) 2023. (PMID 36980028)
• —Molloy S, et al. Focal correction of severe fixed kyphosis with single-level posterior Ponte osteotomy and interbody fusion. Cureus 2016. (PMID 27462479)