Multiple Ponte osteotomies with low implant density: Is it enough for correction of Scheuermann's kyphosis?

CONTEXT: Posterior-only pedicle screw fixation is now the leading surgical treatment for Scheuermann's kyphosis (SK). However, high-density screw constructs increase the risk of malpositioning complications and elevate overall surgical costs. AIMS: To evaluate the safety and clinical efficacy of the low screw density (LSD) technique combined with multiple Ponte osteotomies for the correction of SK. SETTINGS AND DESIGN: This prospective case series was conducted at Kasr Al-Aini and Al-Salam International Hospitals. SUBJECTS AND METHODS: This study was conducted between December 2020 and December 2022 and enrolled 30 patients who underwent posterior-only correction using the LSD approach and multilevel Ponte osteotomies. RESULTS: The cohort (mean age 20.5 years; range 13-37) presented with a mean preoperative maximum kyphosis of 85.9° (range 75°-108°) and a mean pelvic incidence-lumbar lordosis (PI-LL) mismatch of 25.9°. Following surgery, the mean maximum kyphosis improved to 46.2° (range 37°-63°), and the PI-LL mismatch was reduced to 7.7°. These corrections remained stable at the 1- and 2-year follow-ups, with no statistically significant loss of sagittal alignment. CONCLUSIONS: The LSD technique, supported by multiple Ponte osteotomies, is a safe and effective surgical strategy for correcting SK, providing stable deformity correction with reduced instrumentation.