Ponte Osteotomy in Pediatric Spine Surgery.

First utilized in spine surgery in the late 1980s, the Ponte osteotomy is a method of surgically shortening the posterior column in order to obtain greater corrective power in the management of kyphosis or kyphoscoliosis. It is accomplished by removal of bone around the articulation of spinal facet joints, which alters the mechanical axis of rotation and enables greater deformity correction potential. This procedure is performed in the following steps: (1) a posterior midline incision is made in order to expose and clear soft tissues from the desired surgical site; (2) the spinous process and base of the lamina are removed to allow for better visualization and working space; (3) the inferior facet is excised, followed by (4) removal of the superior facet and the (5) ligamentum flavum. If performed correctly, this procedure should allow for appropriate deformity correction and the ability to place desired instrumentation without problems.