Clinical Outcomes of Multilevel Asymmetrical Ponte Osteotomy in Neuromuscular Scoliosis: A 2-Year Retrospective Comparison

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Study Design Retrospective comparative study. Objective Neuromuscular scoliosis (NMS) is a complex deformity requiring individualized surgical strategies focused on improving sitting balance and quality of life. This study aimed to evaluate the clinical efficacy and safety of multilevel asymmetrical Ponte osteotomy (MAPO) in NMS patients, compared to conventional posterior fusion without osteotomy. Methods A retrospective review was conducted on 90 patients with NMS who underwent posterior spinal correction between 2015 and 2021. Patients were divided into a MAPO group (n = 52) and a control group (n = 38). Radiographic parameters and health-related quality of life (SRS-22) were assessed preoperatively, postoperatively, and at ≥2-year follow-up. Perioperative data, including operative time, blood loss, transfusion volume, and complications, were analyzed. Results Baseline characteristics were comparable. The MAPO group achieved significantly greater correction in major curve angle (49.75% vs 46.34%, P = 0.031), pelvic obliquity (25.26% vs 20.81%, P = 0.048), and sagittal vertical axis (33.99% vs 30.08%, P = 0.045). Postoperative satisfaction (4.43 ± 0.55 vs 4.11 ± 0.57, P = 0.026) and function scores (4.39 ± 0.48 vs 4.10 ± 0.61, P = 0.040) were also significantly higher in the MAPO group. However, MAPO was associated with longer operative time (311 vs 229 min, P < 0.001), greater blood loss (685 vs 289 mL, P < 0.001), and a trend toward increased complications, including wound issues and CSF leaks. Conclusions MAPO offers improved deformity correction and higher patient satisfaction compared to non-osteotomy procedures in NMS, though with increased surgical complexity. It may serve as a valuable option for selected patients when balancing benefits and risks.

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