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Management of Adult Idiopathic Scoliosis via the HiPoAD Technique

March 01, 2020

Contributors: Ilaria Chiaramonte, MD; Michele Fiore, MD; Alessandro Panciera, MD; Stefano Pasini Sr, MD; Fabrizio Perna; Alberto Ruffilli, MD, PhD; Angelo Toscano, MD; Francesco Traina, MD, PhD; Cesare Faldini, MD

2020 AWARD WINNER Adolescent idiopathic scoliosis, which progresses in adults usually is associated with secondary degenerative changes. Adult idiopathic scoliosis often is stiffer compared with adolescent idiopathic scoliosis, usually revealing little changes on bending radiographs. The most suitable surgical technique for the management of adult idiopathic scoliosis is a subject of debate. This video demonstrates the management of adult idiopathic scoliosis via an innovative surgical technique that involves a high-density pedicle screw system, Ponte osteotomy, asymmetric rod contouring, and direct vertebral rotation. We call this the HiPoAD technique. The video will demonstrate how to perform an asymmetric Ponte osteotomy via a step-by-step approach and multiple illustrations. A high-density pedicle screw system helps distribute applied forces on more pedicles during the corrective maneuvers with decreased risks of screws pull out or pedicle breakage. The Ponte osteotomy was originally described to manage a long segment of thoracic kyphosis by shortening the posterior column in a single posterior stage. A modified Ponte osteotomy with asymmetric bone resection affords frontal plane correction in a scoliotic spine via convex compression and concave distraction. Asymmetric rod contouring involves placing an under-shaped rod adjacent to the screw heads at the level of apical vertebrae on the convex side and placing an over-shaped rod far distant on the concave side to restore kyphosis and segmental rotation. Asymmetric rod contouring is used in combination with direct vertebral rotation, which is considered the most effective procedure for axial deformity correction. All phases of the HiPoAD technique are shown, and the mean 2-year clinical and radiographic outcomes of 18 patients with adult idiopathic scoliosis who underwent the HiPoAD technique are discussed.