{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T10:37:42Z","timestamp":1769510262233,"version":"3.49.0"},"reference-count":36,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T00:00:00Z","timestamp":1677456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Ponte osteotomy is an increasingly popular technique for multiplanar correction of adolescent idiopathic scoliosis. Prior cadaveric studies have suggested that sequential posterior spinal releases increase spinal flexibility. Here we introduce a novel technique involving a sequential approach to the Ponte osteotomy that minimizes spinal canal exposure. One fresh-frozen adult human cadaveric thoracic spine specimen with 4 cm of ribs was divided into three sections (T1\u2013T5, T6\u2013T9, T10\u2013L1) and mounted for biomechanical testing. Each segment was loaded with five Newton meters under four conditions: baseline inferior facetectomy with supra\/interspinous ligament release, superior articular process (SAP) osteotomy in situ, spinous process (SP) osteotomy in situ, and complete posterior column osteotomy with SP\/SAP excision and ligamentum flavum release (PCO). Compared to baseline, in situ SAP osteotomy alone provided 3.5%, 7.6%, and 7.2% increase in flexion\/extension, lateral bending, and axial rotation, respectively. In situ SP osteotomy increased flexion\/extension, lateral bending, and axial rotation by 15%, 18%, and 10.3%, respectively. PCO increased flexion\/extension, lateral bending, and axial rotation by 19.6%, 28.3%, and 12.2%, respectively. Our report introduces a novel approach where incremental increases in range of motion can be achieved with minimal spinal canal exposure and demonstrates feasibility in a cadaveric model.<\/jats:p>","DOI":"10.3390\/children10030470","type":"journal-article","created":{"date-parts":[[2023,2,28]],"date-time":"2023-02-28T03:00:38Z","timestamp":1677553238000},"page":"470","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Introduction of a Novel Sequential Approach to the Ponte Osteotomy to Minimize Spinal Canal Exposure"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8442-7831","authenticated-orcid":false,"given":"Ian","family":"Hollyer","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Lucile Packard Children\u2019s Hospital at Stanford, Stanford, CA 94304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taylor Renee","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lucile Packard Children\u2019s Hospital at Stanford, Stanford, CA 94304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2462-5940","authenticated-orcid":false,"given":"Stephanie Tieu","family":"Kha","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lucile Packard Children\u2019s Hospital at Stanford, Stanford, CA 94304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron","family":"Foreman","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lucile Packard Children\u2019s Hospital at Stanford, Stanford, CA 94304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivian","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lucile Packard Children\u2019s Hospital at Stanford, Stanford, CA 94304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Klemt","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lucile Packard Children\u2019s Hospital at Stanford, Stanford, CA 94304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Calvin K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Stanford University, Stanford, CA 94305, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2526-4489","authenticated-orcid":false,"given":"John Schoeneman","family":"Vorhies","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Lucile Packard Children\u2019s Hospital at Stanford, Stanford, CA 94304, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E1159","DOI":"10.1097\/BRS.0000000000000467","article-title":"Three-dimensional characterization of torsion and asymmetry of the intervertebral discs versus vertebral bodies in adolescent idiopathic scoliosis","volume":"39","author":"Brink","year":"2014","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1748-7161-1-2","article-title":"Adolescent idiopathic scoliosis: Natural history and long term treatment effects","volume":"1","author":"Asher","year":"2006","journal-title":"Scoliosis"},{"key":"ref_3","first-page":"529","article-title":"Adolescent idiopathic scoliosis: Etiology, anatomy, natural history, and bracing","volume":"54","author":"Parent","year":"2005","journal-title":"Instr. Course Lect."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/S0140-6736(08)60658-3","article-title":"Adolescent idiopathic scoliosis","volume":"371","author":"Weinstein","year":"2008","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bettany-Saltikov, J., Weiss, H.R., Chockalingam, N., Taranu, R., Srinivas, S., Hogg, J., Whittaker, V., Kalyan, R.V., and Arnell, T. (2015). Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD010663.pub2"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S88","DOI":"10.1097\/BPO.0b013e3181f73bd4","article-title":"The role of posterior spinal osteotomies in pediatric spinal deformity surgery: Indications and operative technique","volume":"31","author":"Diab","year":"2011","journal-title":"J. Pediatr. Orthop."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1007\/s00586-012-2625-0","article-title":"Five-year clinical and radiographic outcomes using pedicle screw only constructs in the treatment of adolescent idiopathic scoliosis","volume":"22","author":"Hwang","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1097\/01.brs.0000176196.94565.d6","article-title":"The treatment of large (>70\u00b0) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: When is anterior release indicated?","volume":"30","author":"Burton","year":"2005","journal-title":"Spine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/01.brs.0000197865.20803.d4","article-title":"Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis","volume":"31","author":"Kim","year":"2006","journal-title":"Spine"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gottlich, C., and Sponseller, P.D. (2020). Ponte osteotomy in pediatric spine surgery. JBJS Essent. Surg. Tech., 10.","DOI":"10.2106\/JBJS.ST.19.00026"},{"key":"ref_11","first-page":"252","article-title":"Do multilevel Ponte osteotomies in thoracic idiopathic scoliosis surgery improve curve correction and restore thoracic kyphosis?","volume":"26","author":"Halanski","year":"2013","journal-title":"Clin. Spine Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1007\/s00586-014-3749-1","article-title":"Ponte osteotomies to treat major thoracic adolescent idiopathic scoliosis curves allow more effective corrective maneuvers","volume":"24","author":"Pizones","year":"2015","journal-title":"Eur. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.jspd.2015.03.002","article-title":"Do Ponte Osteotomies Enhance Correction in Adolescent Idiopathic Scoliosis? An Analysis of 191 Lenke 1A and IB Curves","volume":"3","author":"Samdani","year":"2015","journal-title":"Spine Deform."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.jspd.2013.03.002","article-title":"Ponte osteotomies with pedicle screw instrumentation in the treatment of adolescent idiopathic scoliosis","volume":"1","author":"Shah","year":"2013","journal-title":"Spine Deform."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/01.BRS.0000109881.63411.48","article-title":"The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: Posterior shortening and pedicle screws","volume":"29","author":"Shufflebarger","year":"2004","journal-title":"Spine"},{"key":"ref_16","first-page":"586","article-title":"The Ponte procedure: Posterior only treatment of Scheuermann\u2019s kyphosis using segmental posterior shortening and pedicle screw instrumentation","volume":"20","author":"Geck","year":"2007","journal-title":"Clin. Spine Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.jspd.2017.06.006","article-title":"The true Ponte osteotomy: By the one who developed it","volume":"6","author":"Ponte","year":"2018","journal-title":"Spine Deform."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E175","DOI":"10.1097\/BRS.0000000000002784","article-title":"Ponte Osteotomies Increase the Risk of Neuromonitoring Alerts in Adolescent Idiopathic Scoliosis Correction Surgery","volume":"44","author":"Buckland","year":"2019","journal-title":"Spine"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Harfouch, E.B., Bunyan, R.F., Al Faraidy, M., Alnemari, H.H., and Bashir, S. (2022). Ponte osteotomies increase risk of intraoperative neuromonitoring alerts in adolescent idiopathic scoliosis surgery. Surg. Neurol. Int., 13.","DOI":"10.25259\/SNI_67_2022"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s43390-021-00339-x","article-title":"Ponte osteotomies in a matched series of large AIS curves increase surgical risk without improving outcomes","volume":"9","author":"Floccari","year":"2021","journal-title":"Spine Deform."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1097\/BRS.0000000000000439","article-title":"Blood loss during posterior spinal fusion for adolescent idiopathic scoliosis","volume":"39","author":"Koerner","year":"2014","journal-title":"Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/S0021-9290(01)00222-6","article-title":"ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion--part I: Ankle, hip, and spine. International Society of Biomechanics","volume":"35","author":"Wu","year":"2002","journal-title":"J. Biomech."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"232","DOI":"10.3171\/2012.6.SPINE111054","article-title":"Hybrid dynamic stabilization: A biomechanical assessment of adjacent and supraadjacent levels of the lumbar spine","volume":"17","author":"Mageswaran","year":"2012","journal-title":"J. Neurosurg. Spine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.jspd.2015.03.006","article-title":"How does spinal release and ponte osteotomy improve spinal flexibility? The law of diminishing returns","volume":"3","author":"Holewijn","year":"2015","journal-title":"Spine Deform."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.jspd.2013.01.006","article-title":"Quantification of increase in three-dimensional spine flexibility following sequential Ponte osteotomies in a cadaveric model","volume":"1","author":"Sangiorgio","year":"2013","journal-title":"Spine Deform."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E141","DOI":"10.1097\/BRS.0000000000000697","article-title":"Biomechanical comparison of ponte osteotomy and discectomy","volume":"40","author":"Wang","year":"2015","journal-title":"Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s00586-014-3499-0","article-title":"Flexibility of thoracic spines under simultaneous multi-planar loading","volume":"26","author":"Borkowski","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1007\/s005860000142","article-title":"The aetiology of idiopathic scoliosis: Biomechanical and neuromuscular factors","volume":"9","author":"Veldhuizen","year":"2000","journal-title":"Eur. Spine J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s11832-011-0327-5","article-title":"The effect of posterior spinal releases on axial correction torque: A cadaver study","volume":"5","author":"Wiemann","year":"2011","journal-title":"J. Child. Orthop."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1097\/BRS.0b013e3181d85ec8","article-title":"Biomechanical analysis of derotation of the thoracic spine using pedicle screws","volume":"35","author":"Cheng","year":"2010","journal-title":"Spine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jspd.2016.10.004","article-title":"Influence of sequential Ponte osteotomies on the human thoracic spine with a rib cage","volume":"5","author":"Mannen","year":"2017","journal-title":"Spine Deform."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"E64","DOI":"10.1097\/00007632-200202010-00007","article-title":"An in vitro human cadaveric study investigating the biomechanical properties of the thoracic spine","volume":"27","author":"Oda","year":"2002","journal-title":"Spine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"315","DOI":"10.3109\/17453678109050109","article-title":"A biomechanical study of the ligamentous stability of the thoracic spine in man","volume":"52","author":"Panjabi","year":"1981","journal-title":"Acta Orthop. Scand."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1016\/j.spinee.2021.03.018","article-title":"Augmented and virtual reality in spine surgery, current applications and future potentials","volume":"21","author":"Ghaednia","year":"2021","journal-title":"Spine J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"E1049","DOI":"10.1097\/BRS.0000000000004037","article-title":"Does navigation make spinal fusion for adolescent idiopathic scoliosis safer? Insights from a national database","volume":"46","author":"Kaur","year":"2021","journal-title":"Spine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1093\/ons\/opw017","article-title":"Navigation and image injection for control of bone removal and osteotomy planes in spine surgery","volume":"13","author":"Kosterhon","year":"2017","journal-title":"Oper. Neurosurg."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/3\/470\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:43:45Z","timestamp":1760121825000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/3\/470"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,27]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["children10030470"],"URL":"https:\/\/doi.org\/10.3390\/children10030470","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,27]]}}}