| Summary: | The purpose of the present paper is to assess if Ponte osteotomies (POs) allow for a better correction in adolescent idiopathic scoliosis (AIS) surgery and to investigate their safety profile. A systematic search of electronic databases was conducted. Inclusion criteria: comparative studies that reported the outcomes of AIS patients who underwent surgical correction through posterior-only approach with and without POs. Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed to estimate the differences between patients treated with and without POs. <i>p</i> < 0.05 was considered significant. In total, 9 studies were included. No significant difference in thoracic kyphosis (TK) change between patients treated with and without POs was found (+3.8°; <i>p</i> = 0.06). Considering only hypokyphotic patients, a significant difference in TK change resulted in POs patients (+6.6°; <i>p</i> < 0.01), while a non-significant TK change resulted in normokyphotic patients (+0.2°; <i>p</i> = 0.96). No significant difference in coronal correction (2.5°; <i>p</i> = 0.10) was recorded. Significant estimated blood loss (EBL) (142.5 mL; <i>p</i> = 0.04) and surgical time (21.5 min; <i>p</i> = 0.04) differences were found with POs. Regarding complications rate, the meta-analysis showed a non-significant log odds ratio of 1.1 (<i>p</i> = 0.08) with POs. In conclusion, POs allow for the restoration of TK in hypokyphotic AIS, without a significantly greater TK change in normokyphotic patients, nor a significantly better coronal correction. Considering the significantly greater EBL and the trend toward a higher complications rate, the correct indication for POs is crucial.
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