Clinical Study Of Ponte Osteotomy Combined With Intervertebral Fusion In The Treatment Of Adult Degenerative Scoliosis

Objective: To observe the orthopedic effect of Ponte osteotomy combined with intervertebral fusion in the treatment of adult degenerative scoliosis,and to analyze the main imaging parameters affecting the prognosis of patients.Methods: the clinical data of 55 adult patients with degenerative scoliosis admitted to our hospital from November 2012 to December 2017 and treated with Ponte osteotomy combined with intervertebral fusion were retrospectively analyzed.The basic clinical data,surgical conditions and postoperative outcomes of patients were record.All the patients were followed up for more than 1 year,and VAS scores,lumbar function Oswestry disability index(ODI)and Frankel spinal cord injury grades were evaluated at preoperative,postoperative 1 year and the last follow-up.Imaging parameters including Cobb's Angle,thoracic kyphosis Angle(TK),lumbar lordosis(LL),sagittal balance(SVA),pelvic incidence Angle(PI),pelvic inclination Angle(PT),sacral inclination Angle(SS)were measured too.Results: 1.Surgical conditions: The operative time was 186.5±32.1 min,intraoperative blood loss was 575±120.5 ml,and the average postoperative follow-up time was 22.4±6.5 months.The incidence of surgical complications was 16.4%,and the main complications were dural tear,wound drainage and scoliosis.2.Treatment effect At 1 year after treatment and at the last follow-up,patients' Cobb's Angle,TPA,SVA,PT,and pi-ll were lower than those before treatment,and TK,LL,PT,and SS were higher than those before treatment,the difference was statistically significant(P < 0.05).At 1 year after treatment and at the last follow-up,VAS score and ODI score of patients with lumbar back pain were lower than those before treatment,and Frankel's spinal cord injury grade was lower than that before treatment,and the difference was statistically significant(P < 0.05).3.Relationship between imaging parameters and prognosis At 1 year and the last follow-up,TPA,PT and pi-ll were positively correlated with patients' VAS and ODI,while TK,LL and SS were negatively correlated with patients' VAS and ODI.PT and pi-ll were positively correlated with the grading of spinal cord injury,while LL was negatively correlated with the grading of spinal cord injury(P < 0.05).Hyperglycemia,osteoporosis,LL,TPA,PT,and pi-ll were independent risk factors for poor prognosis(P < 0.05,Exp(B)> 1.0).Conclusion: 1.Ponte osteotomy combined with intervertebral fusion could get good orthopedic effect =-in the treatment of adult degenerative scoliosis.2.In the imaging parameters of degenerative scoliosis,LL,TPA,PT and pi-ll are closely related to the prognosis of patients,which can be monitored as a key point.