Efficacy of Ponte Osteotomies in the Surgical Treatment of Scheuermann's Disease: An Analysis of Optimal Spinal Levels for Correction

Purpose: Scheuermann's kyphosis is a structural spinal deformity that typically develops before puberty, affecting the thoracic or thoracolumbar spine. Ponte osteotomy is a widely used surgical technique for multiplanar correction of this condition. This study aims to evaluate the radiographic outcomes and effectiveness of Ponte osteotomies in the surgical treatment of Scheuermann’s kyphosis, and to determine the optimal spinal levels for osteotomy to achieve ideal sagittal alignment. Methods: A retrospective review was conducted on 63 patients who underwent Ponte osteotomies combined with posterior spinal fusion for the correction of Scheuermann’s kyphosis between 2018 and 2022. Radiographic parameters including thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), and pelvic incidence–lumbar lordosis mismatch (PI–LL), were measured preoperatively, postoperatively, and at a two-year follow-up. The number and location of Ponte osteotomies were analyzed in relation to the degree of correction achieved. Results: The study included 63 patients (42% male, 58% female), with a mean age of 20.4 years. The mean TK was significantly reduced from 78.52° ± 6.47° preoperatively to 44.67° ± 4.98° postoperatively (p < 0.001), with correction maintained at follow-up. Significant improvements were also observed in lumbar lordosis (LL) and the pelvic incidence–lumbar lordosis mismatch (PI–LL). The greatest angular corrections were achieved at the T9–T10 and T10–T11 levels. Intervertebral disc height analysis revealed consistent anterior disc opening, stable central height, and decreased posterior disc height postoperatively. No statistically significant correlation was found between anterior disc height increase and Cobb angle correction. Conclusion: Ponte osteotomies are effective in achieving and maintaining significant TK correction in patients with Scheuermann’s disease. Optimal sagittal alignment is best achieved by targeting the osteotomies at the apical region and adjacent levels, with a relatively low rate of complications.