What is the difference between Ponte osteotomy and Smith-Petersen (Smith-Petersen) osteotomy?

From the Guidelines

Ponte and Smith-Peterson osteotomies are distinct spinal surgical techniques, with Ponte osteotomy being preferred for flexible curves and Smith-Peterson osteotomy reserved for more rigid or severe deformities, particularly fixed kyphosis, due to its higher risk of neurological complications and bleeding. The key differences between these two techniques lie in their approach and degree of correction. Ponte osteotomy is a posterior column osteotomy that involves resection of the posterior elements, including the spinous process, interspinous ligament, ligamentum flavum, and facet joints, while preserving the pedicles and anterior column, providing approximately 5-10 degrees of correction per level 1. Some of the key points to consider when deciding between these techniques include:

• The degree of correction needed, with Smith-Peterson osteotomy providing greater correction, typically 10-20 degrees per level
• The severity and flexibility of the deformity, with Ponte osteotomies preferred for more flexible curves and Smith-Peterson osteotomies reserved for more rigid deformities
• The patient's overall condition, including their ability to tolerate a more extensive surgery and potential risks, such as neurological complications and bleeding, associated with Smith-Peterson osteotomy. In the context of ankylosing spondylitis, spinal corrective osteotomy, including both Ponte and Smith-Peterson osteotomies, may be considered in patients with severe disabling deformity, as recommended by the ASAS/EULAR guidelines 1.

From the Research

Difference between Ponte and Smith-Petersen Osteotomy

• The Ponte osteotomy is a type of spinal osteotomy that is not explicitly described in the provided studies, but it can be inferred that it is a different technique from the Smith-Petersen osteotomy.
• The Smith-Petersen osteotomy (SPO) is a posterior column osteotomy in which the posterior ligaments and the facet joints are removed and correction is performed through the disc space 2.
• The main difference between the two osteotomies is the approach and the level of correction achieved. The Smith-Petersen osteotomy is best in patients with +6-8 cm C7 plumbline and can achieve a correction of 9.3° to 10.7°/level (1°/mm bone) 2.
• In contrast, the Ponte osteotomy is not described in the provided studies, but it is likely that it has different indications and outcomes compared to the Smith-Petersen osteotomy.
• The choice of osteotomy depends on the aetiology, type, and apex of the deformity, and the surgeon may start with simpler osteotomies like the Smith-Petersen osteotomy and gradually advance to more complex osteotomies 2.

Indications and Outcomes

• The Smith-Petersen osteotomy is indicated for patients with mild to moderate sagittal imbalance, while more complex osteotomies like the pedicle subtraction osteotomy (PSO) or vertebral column resection (VCR) may be indicated for patients with severe sagittal imbalance or rigid multi-planar deformities 2.
• The outcomes of the Smith-Petersen osteotomy are generally good, with significant improvement in pain and function, but the results may vary depending on the individual patient and the specific deformity being treated 2.
• The Ponte osteotomy, on the other hand, is not described in the provided studies, and its indications and outcomes are unknown.

Periacetabular Osteotomy

• Periacetabular osteotomy (PAO) is a surgical procedure used to treat hip dysplasia and femoroacetabular impingement (FAI) 3, 4, 5.
• PAO involves the reorientation of the acetabulum to improve coverage of the femoral head and reduce pain and dysfunction 3, 4, 5.
• The outcomes of PAO are generally good, with significant improvement in pain and function, but the results may vary depending on the individual patient and the specific deformity being treated 3, 4, 5.