A meta-analysis comparing the efficacy and safety of multi-level Ponte osteotomy and vertebral column resection in correcting complex spinal deformities

English Keywords:Spinal deformity  Multi-level Ponte osteotomy  Vertebral column resection  Scoliosis  Kyphosis  Meta analysis

English Abstract:

  【Abstract】 Objectives: To systematically evaluate and compare the efficacy and safety of multi-level Ponte osteotomy and vertebral column resection(VCR) in the correction of complex spinal deformities. Methods: The clinical research literatures on the comparison of the effects of two surgical methods(Ponte osteotomy and VCR) on the correction of complex spinal deformities in CNKI, Wanfang, VIP, PubMed, Cochrane Library, EMBASE and CBM databases until June 2023 were retrieved by computer. Three researchers independently screened literatures and extracted data, and comprehensively evaluated the quality of the included literatures by using the modified Jadad scale and Newcastle-Ottawa Scale(NOS). The included indicators were operative time, intraoperative blood loss, postoperative complications, Cobb angle correction rate of main curve, kyphosis correction rate, SRS-22 score, Cobb angle correction loss of main curvae, kyphosis correction loss, and Revman 5.3 software was used for meta-analysis. Results: A total of 6 literatures were included, including 1 cohort study with Jadad scale score of 3 and quality grade of B, and 5 cohort studies with Jadad and NOS scale scores of more than 5. A total of 198 patients with complex spinal deformities after operation were included, consisting of 118 cases undergone multi-level Ponte osteotomy(Ponte group) and 80 cases undergone VCR(VCR group). The results showed that comparing with VCR, multi-level Ponte osteotomy had shorter operative time[OR=-43.08, 95%CI(-58.46, -27.70), Z=5.49, P<0.00001], less blood loss[OR=-214.06, 95%CI (-336.10, -92.02), Z=3.44, P=0.0006] and less postoperative complications[OR=0.13, 95%CI(0.05, 0.31), Z=4.50, P<0.00001]; There was no statistical difference in postoperative Cobb angle correction rate[OR=1.53, 95%CI(-3.24, 6.31), Z=0.63, P>0.05], kyphosis correction rate[OR=6.40, 95%CI(-0.35, 13.15), Z=1.89, P>0.05], SRS-22 score[OR=-0.06, 95%CI(-0.44, 0.33), Z=0.29, P>0.05], Cobb angle correction loss[OR=0.15, 95%CI(-1.08, 1.38), Z=0.24, P>0.05], and correction loss of kyphosis[OR=0.33, 95%CI(-3.44, 4.10), Z=0.17, P>0.05] between the two groups. Conclusions: The clinical effects of multi-level Ponte osteotomy and VCR for the correction of complex spinal deformities are similar, but Ponte osteotomy is better than VCR in operative time, intraoperative blood loss and postoperative complications, which is a more safe and effective method.