Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis

<sec><title>Study Design</title>Retrospective analysis.</sec><sec><title>Purpose</title>Our hypothesis is that the surgical correction of adolescent idiopathic scoliosis (AIS) maintains normal sagittal alignment as compared to age-matched normative adolescent population.</sec><sec><title>Overview of Literature</title>Sagittal spino-pelvic alignment in AIS has been reported, however, whether corrective spinal fusion surgery re-establishes normal alignment remains unverified.</sec><sec><title>Methods</title>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.</sec><sec><title>Results</title>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><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.</sec><sec><title>Conclusions</title>Surgical correction of the coronal plane in AIS patients preserves sagittal and spino-pelvic alignment as compared to age-matched asymptomatic adolescents.</sec>

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Letter to the Editor concerning “Post-operative Distal Coronal Decompensation after Fusion to L3 for Adolescent Idiopathic Scoliosis is affected by Sagittal Pelvic Parameters” by So Kato.

Spine ◽

10.1097/brs.0000000000003900 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Bowen Hu ◽

Xi Yang

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pelvic Parameters ◽

Letter To The Editor ◽

Coronal Decompensation

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

Studies in Health Technology and Informatics - Research into Spinal Deformities 9 ◽

10.3233/shti210459 ◽

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.

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Revision Strategies for Harrington Rod Instrumentation: Radiographic Outcomes and Complications

Global Spine Journal ◽

10.1177/2192568220960759 ◽

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.

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Postoperative Distal Coronal Decompensation After Fusion to L3 for Adolescent Idiopathic Scoliosis Is Affected by Sagittal Pelvic Parameters

Spine ◽

10.1097/brs.0000000000003616 ◽

2020 ◽

Vol 45 (21) ◽

pp. E1416-E1420

Author(s):

So Kato ◽

Reinhard D. Zeller ◽

Sofia P. Magana ◽

Mario Ganau ◽

Yasushi Oshima ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pelvic Parameters ◽

Coronal Decompensation

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Long-term effects of the Chêneau brace on coronal and sagittal alignment in adolescent idiopathic scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2015.2.spine14970 ◽

2015 ◽

Vol 23 (4) ◽

pp. 505-509 ◽

Cited By ~ 18

Author(s):

Ming-Qiao Fang ◽

Chong Wang ◽

Guang-Heng Xiang ◽

Chao Lou ◽

Nai-Feng Tian ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Sagittal Alignment ◽

Vertical Axis ◽

Sacral Slope ◽

Long Term Effects ◽

Sagittal Vertical Axis ◽

Pelvic Parameters

OBJECT The aim of the present study was to retrospectively evaluate progressive correction of coronal and sagittal alignment and pelvic parameters in patients treated with a Chêneau brace. METHODS Thirty-two patients with adolescent idiopathic scoliosis (AIS) were assessed before initiation of bracing treatment and at the final follow-up. Each patient underwent radiological examinations, and coronal, sagittal, and pelvic parameters were measured. RESULTS No statistically significant modification of the Cobb angle was noted. The pelvic incidence remained unchanged in 59% of the cases and increased in 28% of the cases. The sacral slope decreased in 34% of the cases but remained unchanged in 50%. Thoracic kyphosis and lumbar lordosis were significantly decreased, whereas the sagittal vertical axis was significantly increased from a mean of -44.0 to -30.2 mm (p = 0.02). The mean pelvic tilt increased significantly from 4.5° to 8.3° (p = 0.002). CONCLUSIONS The Chêneau brace can be useful for preventing curvature progression in patients with AIS. However, the results of this study reveal high variability in the effect of brace treatment on sagittal and pelvic alignment. Treatment with the Chêneau brace may also influence sagittal global balance.

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How Sublaminar Bands Affect Postoperative Sagittal Alignment in AIS Patients with Preoperative Hypokyphosis? Results of a Series of 34 Patients with 2-Year Follow-Up

BioMed Research International ◽

10.1155/2016/1954712 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Sébastien Pesenti ◽

Antoine Chalopin ◽

Emilie Peltier ◽

Elie Choufani ◽

Matthieu Ollivier ◽

...

Keyword(s):

Idiopathic Scoliosis ◽

Cobb Angle ◽

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Radiographic Evaluation ◽

Cervical Lordosis ◽

Pelvic Parameters ◽

Sublaminar Bands ◽

Thoracic Idiopathic Scoliosis

Hypokyphosis is currently observed in thoracic idiopathic scoliosis. The use of sublaminar bands allows a good restoration of sagittal balance of the spine. The aim of the study was to provide a middle-term radiographic analysis of patients with adolescent idiopathic scoliosis with preoperative hypokyphosis treated by posterior arthrodesis with sublaminar bands. This retrospective study included 34 patients with Lenke 1 scoliosis associated with hypokyphosis (TK < 20°). A radiographic evaluation was performed with a 2-year follow-up. Cobb angle, cervical lordosis, thoracic kyphosis, lumbar lordosis, and pelvic parameters were measured preoperatively, postoperatively, and at 6-month and 2-year follow-up. The mean preoperative thoracic kyphosis was 10.5° versus 24.1° postoperatively (p<0.001), representing a mean gain of 13°. Cobb angle ranged from 59.3° to 17.9° postoperatively (mean correction 69%,p<0.001). Cobb angle increased between the immediate postoperative measurement and the 6-month follow-up (17.9 versus 19.9,p=0.03). Cervical curvature changed from a 5.6° kyphosis to a 3.5° lordosis (p=0.001). Concerning lumbar lordosis, preoperative measurement was 39.7° versus 41.3° postoperatively (p=0.27). At 6-month follow-up, lumbar lordosis significantly increased to 43.6° (p=0.03). All parameters were stable at final follow-up. Correction performed by sublaminar bands is efficient for both fontal and sagittal planes. Moreover, the restoration of normal thoracic kyphosis is followed by an adaptation of the adjacent curvatures with improved cervical lordosis and lumbar lordosis.

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Maintaining Lumbar Lordosis With Anterior Single Solid-Rod Instrumentation in Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis

Spine ◽

10.1097/00007632-199908150-00006 ◽

1999 ◽

Vol 24 (16) ◽

pp. 1655 ◽

Cited By ~ 54

Author(s):

Fred A. Sweet ◽

Lawrence G. Lenke ◽

Keith H. Bridwell ◽

Kathy M. Blanke

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Lumbar Lordosis

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Patterns of coronal and sagittal deformities in adolescent idiopathic scoliosis

10.21203/rs.3.rs-42561/v3 ◽

2021 ◽

Author(s):

Trixie Mak ◽

Prudence Wing Hang Cheung ◽

Teng Zhang ◽

Jason Pui Yin Cheung

Keyword(s):

Quality Of Life ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Sagittal Profile ◽

Sacral Slope ◽

Pelvic Parameters ◽

Curve Magnitude ◽

Sagittal Parameters

Abstract Background: Thoracic scoliosis has been shown to be associated with hypokyphosis in adolescent idiopathic scoliosis (AIS). However, the relationship of sagittal spino-pelvic parameters with different coronal curve patterns and their influence on patient-perceived quality of life is unknown. This study aims to determine the association between coronal and sagittal malalignment in patients with AIS and to determine their effects on SRS-22r scores. Methods: A cross-sectional study was conducted on 1054 consecutive patients with AIS. The coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PI-LL mismatch (PI-LL), pelvic tilt (PT), and sacral slope (SS) were measured on standing radiographs. The coronal Cobb angle (mild: 10-20°; moderate: >20-40°; severe: >40°) and PI (low: <35°; average: 35-50°; high: >50°) were divided into 3 sub-groups for comparison. Relationship between coronal curve magnitudes and sagittal parameters was studied as was their association with SRS-22r scores. Results: Low PI had smaller SS (30.1±8.3° vs 44.8±7.7°; p<0.001), PT (-0.3±8.1° vs 14.4±7.5°; p<0.001), and LL (42.0±13.2° vs 55.1±10.6°; p<0.001), negative PI-LL mismatch (-12.1±13.1° vs 4.1±10.5°; p<0.001) as compared to large PI. There were no significant relationships with PI and TK (p=0.905) or curve magnitude (p=0.431). No differences in sagittal parameters were observed for mild, moderate or severe coronal Cobb angles. SRS-22r scores only correlated with coronal Cobb angle and larger Cobb angles were negatively correlated with the function, appearance and pain domains. Conclusions: The sagittal profile for AIS is associated with the pelvic parameters especially PI but not with the coronal curve pattern. All patients have a similar TK regardless of coronal curve type. However, it appears that the coronal deformity is a greater influence on quality of life outcomes especially those >40°.

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The Effects of Bracing on Pelvic Parameters in Adolescent Idiopathic Scoliosis

10.21203/rs.3.rs-240717/v1 ◽

2021 ◽

Author(s):

Kepeng Li ◽

Jun Miao ◽

Jingan Zhang ◽

Xijie Wang ◽

Ye Han

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Sagittal Plane ◽

Coronal Plane ◽

Sacral Slope ◽

Spinopelvic Parameters ◽

Vertical Angle ◽

Pelvic Parameters ◽

Cobb’S Angle ◽

The Mean

Abstract Background: This study aims to evaluate the effects of bracing on the Cobb’s angle (CA) and spinopelvic parameters in adolescent idiopathic scoliosis (AIS) patients. Methods: A total of 51 AIS patients who received bracing treatment between January 2018 and August 2019 were retrospectively analyzed. The pro-bracing and in-bracing radiographs were analyzed with regard to the spinopelvic parameters. The CA, pelvic coronal obliquity angle (PCOA), thoracolumbar kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical angle (SVA) and coronal vertical angle (CVA) were measured. Results: The mean age at the initiation of bracing was 13.6 ± 1.5 years. The mean pro-bracing CA was 24.0° ± 6.3°. There were no statistically significant differences between pro-bracing and in-bracing measurements of SVA and CVA. However, there were statistically significant differences between the pro-bracing and in-bracing measurements of the CA, PCOA, TLK, LL, PT and SS. A significant correlation was observed between PT variation and TLK variation in the sagittal plane. In the coronal plane, the PCOA variation was correlated to pro-bracing PCOA. Conclusion: Bracing effects of AIS can be extended to the pelvis. The pelvis should retro-rotate correspondingly to TLK hypokyphosis on sagittal plane, whereas in coronal plane, pelvic obliquity was improved independently.

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