Mismatch between Pelvic Incidence and Lumbar Lordosis is the Key Sagittal Plane Determinant of Patient Outcome at minimum 40 Years after Instrumented Fusion for Adolescent Idiopathic Scoliosis

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Paul T. Rubery ◽  
Sarah T. Lander ◽  
Addisu Mesfin ◽  
James O. Sanders ◽  
Caroline P. Thirukumaran
Keyword(s):  
Patient Outcome ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Sagittal Plane ◽  
Instrumented Fusion

scholarly journals Normal Age-Adjusted Sagittal Spinal Alignment Is Achieved with Surgical Correction in Adolescent Idiopathic Scoliosis

2017 ◽  
Vol 11 (5) ◽  
pp. 770-779 ◽  
Author(s):  
Subaraman Ramchandran ◽  
Norah Foster ◽  
Akhila Sure ◽  
Thomas J. Errico ◽  
Aaron J. Buckland
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pelvic Incidence ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Surgical Correction ◽  
Sagittal Vertical Axis

<sec><title>Study Design</title><p>Retrospective analysis.</p></sec><sec><title>Purpose</title><p>Our hypothesis is that the surgical correction of adolescent idiopathic scoliosis (AIS) maintains normal sagittal alignment as compared to age-matched normative adolescent population.</p></sec><sec><title>Overview of Literature</title><p>Sagittal spino-pelvic alignment in AIS has been reported, however, whether corrective spinal fusion surgery re-establishes normal alignment remains unverified.</p></sec><sec><title>Methods</title><p>Sagittal profiles and spino-pelvic parameters of thirty-eight postsurgical correction AIS patients ≤21 years old without prior fusion from a single institution database were compared to previously published normative age-matched data. Coronal and sagittal measurements including structural coronal Cobb angle, pelvic incidence, pelvic tilt, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, C2–C7 cervical lordosis, C2–C7 sagittal vertical axis, and T1 pelvic angles were measured on standing full-body stereoradiographs using validated software to compare preoperative and 6 months postoperative changes with previously published adolescent norms. A sub-group analysis of patients with type 1 Lenke curves was performed comparing preoperative to postoperative alignment and also comparing this with previously published normative values.</p></sec><sec><title>Results</title><p>The mean coronal curve of the 38 AIS patients (mean age, 16±2.2 years; 76.3% female) was corrected from 53.6° to 9.6° (80.9%, <italic>p</italic>&lt;0.01). None of the thoracic and spino-pelvic sagittal parameters changed significantly after surgery in previously hypo- and normo-kyphotic patients. In hyper-kyphotic patients, thoracic kyphosis decreased (<italic>p</italic>=0.003) with a reciprocal decrease in lumbar lordosis (<italic>p</italic>=0.01), thus lowering pelvic incidence-lumbar lordosis mismatch mismatch (<italic>p</italic>=0.009). Structural thoracic scoliosis patients had slightly more thoracic kyphosis than age-matched patients at baseline and surgical correction of the coronal plane of their scoliosis preserved normal sagittal alignment postoperatively. A sub-analysis of Lenke curve type 1 patients (n=24) demonstrated no statistically significant changes in the sagittal alignment postoperatively despite adequate coronal correction.</p></sec><sec><title>Conclusions</title><p>Surgical correction of the coronal plane in AIS patients preserves sagittal and spino-pelvic alignment as compared to age-matched asymptomatic adolescents.</p></sec>

scholarly journals Revision Strategies for Harrington Rod Instrumentation: Radiographic Outcomes and Complications

2020 ◽  
pp. 219256822096075
Author(s):  
Philip K. Louie ◽  
Sravisht Iyer ◽  
Krishn Khanna ◽  
Garrett K. Harada ◽  
Alina Khalid ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Revision Surgery ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
Radiographic Outcomes ◽  
Harrington Rod

Study Design: Retrospective case series. Objective: The purpose of this study is to evaluate the clinical and radiographic outcomes following revision surgery following Harrington rod instrumentation. Methods: Patients who underwent revision surgery with a minimum of 1-year follow-up for flatback syndrome following Harrington rod instrumentation for adolescent idiopathic scoliosis were identified from a multicenter dataset. Baseline demographics and intraoperative information were obtained. Preoperative, initial postoperative, and most recent spinopelvic parameters were compared. Postoperative complications and reoperations were subsequently evaluated. Results: A total of 41 patients met the inclusion criteria with an average follow-up of 27.7 months. Overall, 14 patients (34.1%) underwent a combined anterior-posterior fusion, and 27 (65.9%) underwent an osteotomy for correction. Preoperatively, the most common lower instrumented vertebra (LIV) was at L3 and L4 (61%), whereas 85% had a LIV to the pelvis after revision. The mean preoperative pelvic incidence–lumbar lordosis mismatch and C7 sagittal vertical axis were 23.7° and 89.6 mm. This was corrected to 8.1° and 28.9 mm and maintained to 9.04° and 34.4 mm at latest follow-up. Complications included deep wound infection (12.2%), durotomy (14.6%), implant related failures (14.6%), and temporary neurologic deficits (22.0%). Eight patients underwent further revision surgery at an average of 7.4 months after initial revision. Conclusions: There are multiple surgical techniques to address symptomatic flatback syndrome in patients with previous Harrington rod instrumentation for adolescent idiopathic scoliosis. At an average of 27.7 months follow-up, pelvic incidence–lumbar lordosis mismatch and C7 sagittal vertical axis can be successfully corrected and maintained. However, complication and reoperation rates remain high.

Thoracoscopic anterior instrumented fusion for adolescent idiopathic scoliosis with emphasis on the sagittal plane

2009 ◽  
Vol 9 (7) ◽  
pp. 523-529 ◽  
Author(s):  
Baron S. Lonner ◽  
Joshua D. Auerbach ◽  
Rafael Levin ◽  
David Matusz ◽  
Carrie L. Scharf ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Sagittal Plane ◽  
Instrumented Fusion

P173. Sagittal Plane Changes According to the Thoracic Kyphosis Change Following Posterior Segmental Spinal Instrumented Fusion of Adolescent Idiopathic Scoliosis

2009 ◽  
Vol 9 (10) ◽  
pp. 202S-203S
Author(s):  
Yongjung Kim ◽  
Lawrence Lenke ◽  
Keith Bridwell ◽  
Oheneba Boachie-Adjei ◽  
Jean-Luc Clement ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Thoracic Kyphosis ◽  
Sagittal Plane ◽  
Instrumented Fusion

Thoracic sagittal plane variations between patients with thoracic adolescent idiopathic scoliosis and healthy adolescents

2016 ◽  
Vol 25 (10) ◽  
pp. 3095-3103 ◽  
Author(s):  
Javier Pizones ◽  
Alberto Núñez-Medina ◽  
Felisa Sánchez-Mariscal ◽  
Lorenzo Zúñiga ◽  
Enrique Izquierdo
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Sagittal Plane

scholarly journals Is There a Correlation between the Apical Vertebral Rotation and the Pelvic Incidence in Adolescent Idiopathic Scoliosis?

2016 ◽  
Vol 6 (1_suppl) ◽  
pp. s-0036-1583044-s-0036-1583044
Author(s):  
Khalil Kharrat ◽  
Amer Sebaaly ◽  
Ayman Assi ◽  
Ismat Ghanem ◽  
Rami Rachkidi
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pelvic Incidence ◽  
Vertebral Rotation ◽  
Apical Vertebral Rotation

The impact of immediate in-brace 3D corrections on curve evolution after two years of treatment: preliminary results

2021 ◽  
Author(s):  
A Guy ◽  
H Labelle ◽  
S Barchi ◽  
CÉ Aubin
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Treatment Outcomes ◽  
Lumbar Lordosis ◽  
Treatment Success ◽  
Curve Evolution ◽  
Preliminary Results ◽  
Coronal Correction ◽  
The Impact

For the brace treatment of adolescent idiopathic scoliosis (AIS), in-brace correction and brace-wear compliance are well-documented parameters associated with a greater chance of treatment success. However, the number of studies on the impact of sagittal and transverse correction on curve evolution in the context of bracing is limited. The objective of this work was to evaluate how immediate inbrace correction in the three anatomical planes is related to long-term curve evolution after two years of bracing. We performed a retrospective analysis on 94 AIS patients followed for a minimum of two years. We analyzed correlations between in-brace correction and two-year out-of-brace evolution for Cobb and apical axial rotations (ARs) in the medial thoracic and thoraco-lumbar/lumbar regions (MT & TL/L). We also studied the association between the braces’ kyphosing and lordosing effect and the evolution of thoracic kyphosis (TK) and lumbar lordosis (LL) after two years. Finally, we separated the patients into three groups based on their curve progression results after two years (corrected, stable and progressed) and compared the 3D in-brace corrections and compliance for each group. Coefficients were statistically significant for all correlations. They were weak for Cobb angles (MT: -0.242; TL/L: -0.275), low for ARs (MT: -0.423; TL/L: -0.417) and moderate for sagittal curves (TK: 0.549; LL: 0.482). In-brace coronal correction was significantly higher in corrected vs stable patients (p=0.004) while compliance was significantly higher in stable vs progressed patients (p=0.026). This study highlights the importance of initial in-brace correction in all three planes for successful treatment outcomes.

scholarly journals A comparison of four techniques to measure anterior and posterior vertebral body heights and sagittal plane wedge angles in adolescent idiopathic scoliosis

2016 ◽  
Vol 55 (4) ◽  
pp. 561-572 ◽  
Author(s):  
Nicolas Newell ◽  
Caroline A. Grant ◽  
Bethany E. Keenan ◽  
Maree T. Izatt ◽  
Mark J. Pearcy ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Vertebral Body ◽  
Sagittal Plane
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