Accurate prediction of spontaneous lumbar curve correction following posterior selective thoracic fusion in adolescent idiopathic scoliosis using logistic regression models and clinical rationale

Abstract Background Postoperative shoulder imbalance is a common complication in adolescent idiopathic scoliosis and may impair patient satisfaction. The little data in the literature on the prediction and treatment of postoperative shoulder imbalance is incongruous. According to some studies, postoperative shoulder imbalance depends on the superior instrumented vertebral bodies, skeletal maturity, extent of correction and flexibility of the major curve. Question Can preoperative radiological parameters from X-ray and traction films as well as correction of the curves be used to identify a factor impacting on postoperative shoulder imbalance? Material and Methods Prospective data in adolescent idiopathic scoliosis with thoracic curve (Lenke type 1), operated on between 2015 and 2018 at a scoliosis centre, were analysed retrospectively based on full-length X-rays of the spine (pre-/postOP and follow-up (FU)) and preoperative-traction films: age; correction of proximal, main and lumbar curve; shoulder height [mm]; clavicle angle [°]; T1 tilt [°]; coronal plumb line deviation [mm]. The findings were expressed as means with standard deviation. Changes in parameters over time (postOP-FU) were compared by t test (significance level α = 0.05). The correlation between preOP parameters and extent of correction with postoperative shoulder imbalance (≥ 15 mm) was determined by Pearson correlation and regression classification analysis. Outcomes 55 patients with adolescent idiopathic scoliosis, mean age of 15 ± 1.4 years. The FU-rate after a mean of 15 months was 80% (n = 44). Correction of proximal, main and lumbar curve: 47.0%, 75.8% and 68.8%, respectively, without statistically significant change (Δ) in FU (p > 0.05). Shoulder height was − 11.0 ± 12.7 mm (preOP), 15.5 ± 13.4 mm (postOP), 10.1 ± 10.6 mm (FU) (p < 0.05). 38% of those with adolescent idiopathic scoliosis had preOP right shoulder elevation; 55% (postOP) and 32% (FU) respectively had postoperative shoulder imbalance (left shoulder elevation). Strong statistical correlation was found for Δshoulder position (FU-preOP) with pre-OP shoulder position (r = − 0.7), and Δshoulder position (pre-OP traction films) (r = 0.5) with pre-OP clavicle angle (r = − 0.5). On regression classification analysis, 81.8% of cases did display postoperative shoulder imbalance if proximal curve correction was ≤ 64.4%; main and lumbar curve correction, Δshoulder elevation (preOP traction films) played a secondary role. Discussion One common complication even in Lenke type 1 adolescent idiopathic scoliosis is postoperative shoulder imbalance. Preoperative planning should include traction films, preoperative shoulder position and clavicle angle to avoid postoperative shoulder imbalance. Moderate correction of proximal curve is critical for postoperative shoulder balance.

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Maintenance of spontaneous lumbar curve correction following thoracic fusion of main thoracic curves in adolescent idiopathic scoliosis

The Bone & Joint Journal ◽

10.1302/0301-620x.98b7.37587 ◽

2016 ◽

Vol 98-B (7) ◽

pp. 997-1002 ◽

Cited By ~ 4

Author(s):

H. S. Sudo ◽

M. M. Mayer ◽

K. K. Kaneda ◽

S. Núñez-Pereira ◽

S. Y. Shono ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Lumbar Curve ◽

Curve Correction ◽

Main Thoracic

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Postoperative Lumbar Curve Progression Deteriorates Shoulder Imbalance in Patients with Lenke Type 2B/C Adolescent Idiopathic Scoliosis Who Underwent Selective Thoracic Fusion

World Neurosurgery ◽

10.1016/j.wneu.2019.01.032 ◽

2019 ◽

Vol 125 ◽

pp. e175-e182 ◽

Cited By ~ 1

Author(s):

Jun Jiang ◽

Ze-zhang Zhu ◽

Yong Qiu ◽

Bin Wang ◽

Yang Yu

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Curve Progression ◽

Lumbar Curve ◽

Selective Thoracic Fusion ◽

Shoulder Imbalance

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Characteristics analysis of Segmental and Regional Lumbar Spontaneous Compensation Post Selective Thoracic Fusion in Lenke 1 and 2 Adolescent Idiopathic Scoliosis

10.21203/rs.3.rs-676609/v1 ◽

2021 ◽

Author(s):

Kai Chen ◽

Xiao Zhai ◽

Tianjunke Zhou ◽

Yu Deng ◽

Shaofeng Chen ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Demographic Data ◽

Wedge Angle ◽

Lumbar Region ◽

Lumbar Curve ◽

Selective Thoracic Fusion ◽

Spontaneous Correction

Abstract ObjectiveTo explore the characteristics of compensation of unfused lumbar region post selective thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis BackgroundPreserving lumbar mobility in the compensation is significant in controlling pain and maintaining its functions. The spontaneous correction of the distal unfused lumbar curve after STF has been widely reported, but previous study has not concentrated on the characteristics of compensation of unfused lumbar region post selective thoracic fusion.MethodA total of 51 Lenke 1 and2 AIS patients were included, whose lowest instrumented vertebrae was L1 from January 2013 to December 2019. For further analysis, demographic data and coronal radiographic films were collected before surgery, at immediate erect postoperatively and final follow-up. The wedge angles of each unfused distal lumbar segments were measured, and the variations in each disc segment were calculated at the immediate postoperative review and final follow-up. Meanwhile, the unfused lumbar curve was divided into upper and lower parts, and calculated their curve angles and compensations.ResultsThe current study enrolled 41 females (80.4%) and 10 males (19.6%). 36 patients were Lenke type 1, while 15 patients were Lenke type 2. The average main thoracic Cobb angle and thoracolumbar/lumbar Cobb angle were 44.1±7.7°and 24.1±9.3°, preoperatively. At the final follow-up, the disc wedge angle variation of L1/2, L2/3, L3/4, L4/5 and L5/S1 was 3.84±5.96°, 3.09±4.54°, 2.30±4.53°, -0.12±3.89° and -1.36±2.80°, respectively. The compensation of upper and lower coronal lumbar curves at final follow-up were 9.22±10.39° and -1.49±5.14°, respectively.ConclusionWhen choosing L1 as the lowest instrumented vertebrae, the distal unfused lumbar segments' compensation showed a decreasing trend from the proximal end to the distal end. The adjacent L1/2 and L2/3 discs significantly contributed to this compensation.

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BESAR KURVA THORAKAL DAN LUMBAL MODIFIER SEBAGAI FAKTOR PREDIKSI TERHADAP KOREKSI SPONTAN KURVA LUMBAL PASKA OPERASI PADA ADOLESCENT IDIOPATHIC SCOLIOSIS LENKE I

Biomedika ◽

10.23917/biomedika.v11i2.7629 ◽

2019 ◽

Vol 11 (2) ◽

pp. 74-80

Author(s):

Anggita Tri Yurisworo ◽

Bagas Widhiarso ◽

Andhi Prijosedjati ◽

Pamudji Utomo

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Posterior Instrumentation ◽

Thoracic Curve ◽

Dominant Factor ◽

X Rays ◽

Lumbar Curve ◽

Curve Correction ◽

Main Thoracic ◽

Before And After

Adolescent idiopathic scoliosis Lenke I dengan pola kurva mayor pada kurva thorakal (main thoracic), dengan kurva proximal thoracic dan thoracolumbar/lumbar sebagai kurva minor non struktural. Instrumentasi dan fusi hanya pada kurva thorakal dianjurkan. Pada literatur dijelaskan bahwa koreksi spontan kurva lumbal terjadi sebagai kompensasi untuk menyeimbangkan kurva thorakal setelah dilakukannya fusi thorakal selektif. Lumbal modifier dibagi menjadi 3 grup, pemilihan terapi operatif bergantung pada tipe lumbal modifier. Penelitian ini merupakan suatu analisis observational pada 35 pasien adolescent idiopathic scoliosis Lenke I paska operasi koreksi deformitas dan instrumentasi posterior. evaluasi menggunakan X ray sebelum dan setelah operasi untuk penentuan tipe lumbal modifier, besarnya koreksi kurva thorakal dan penilaian koreksi spontan kurva lumbal, kemudian dilakukan uji korelasi terhadap data yang didapat. Besarnya koreksi kurva thorakal terhadap koreksi spontan kurva lumbal paska operasi memiliki nilai signifikansi (Sig) = 0,000 < 0,05 dan besarnya koreksi kurva thorakal memiliki nilai koefisien regresi lebih besar bila dibandingkan dengan lumbal modifier terhadap koreksi spontan kurva lumbal paska operasi (variabel besar koreksi kurva thorakal (X1) = 0,764, Lumbal modifier (X2) = 0,092). Besarnya koreksi kurva thorakal berpengaruh signifikan terhadap koreksi spontan kurva lumbal paska operasi dan besarnya koreksi kurva thorakal yang paling dominan dalam mempengaruhi koreksi spontan kurva lumbal dibandingkan dengan lumbal modifier.Kata kunci : Adolescent idiopathic scoliosis, Lumbal modifier, kurva thorakal Adolescent idiopathic scoliosis Lenke I, main thoracic curve pattern has the major curve, with the proximal thoracic and thoracolumbar/lumbar being non structural minor curves. Thus, instrumentation and fusion of the main thoracic region alone is recommended. In the literature it is said that the lumbar curve spontaneously corrects to balance the thoracic curve after selective thoracic fusion. Most authors assumed a mechanism whereby improvement of the lumbar curve occurred through counterbalancing the surgical correction of the thoracic curve. The lumbar curve divided in three subgroups: lumbar modifier A, B and C. The selection of specific operative treatments depends on this modifier. This study was an observational analysis in 35 adolescent idiopathic scoliosis Lenke I patients after correction and posterior instrumentation surgery. Evaluation using X-rays before and after surgery to determine the type of lumbar modifier, the magnitude of the main thoracic curve and assessment of spontaneous lumbar curve correction, then correlation test obtained. The magnitude of main thoracic curve correction to the spontaneous lumbar curve correction has a significance value (Sig) = 0.000 < 0.05 and the magnitude of main thoracic curve correction has a greater regression coefficient than the lumbar modifier for spontaneous lumbar curve correction (large correction variable thoracic curve (X1) = 0.764, Lumbal modifier (X2) = 0.092). The magnitude of main thoracic curve correction has a significant effect on the spontaneous lumbar curve correction and the magnitude of main thoracic curve correction is most dominant factor to influence spontaneous lumbar curve correction compared to the lumbar modifier.Keywords: Adolescent idiopathic scoliosis, Lumbar modifier, main thoracic

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