scholarly journals Assessment of spontaneous correction of lumbar curve after fusion of the main thoracic in Lenke 1 adolescent idiopathic scoliosis

2016 ◽  
Vol 51 (1) ◽  
pp. 83-89 ◽  
Author(s):  
Danilo Mizusaki ◽  
Alberto Ofenhejm Gotfryd
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Lumbar Curve ◽  
Main Thoracic ◽  
Spontaneous Correction

scholarly journals Characteristics analysis of segmental and regional lumbar spontaneous compensation post thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kai Chen ◽  
Xiao Zhai ◽  
Tianjunke Zhou ◽  
Yu Deng ◽  
Beichen Zhang ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Demographic Data ◽  
Wedge Angle ◽  
Lumbar Region ◽  
Lumbar Curve ◽  
Angle Variation ◽  
Spontaneous Correction

Abstract Objective To explore the characteristics of compensation of unfused lumbar region post thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis. Background Preserving 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 thoracic fusion. Method A 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 we calculated their curve angles and compensations. Results The current study enrolled 41 females (80.4%) and 10 males (19.6%). Thirty-six 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. Conclusion When 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.

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

2016 ◽  
Vol 98-B (7) ◽  
pp. 997-1002 ◽  
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

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

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.

scholarly journals RADIOGRAPHICAL ANALYSIS OF FLEXIBILITY OF IDIOPATIC SCOLIOSIS IN PRONO AND SUPINO

2020 ◽  
Vol 19 (1) ◽  
pp. 13-17
Author(s):  
MARCELO PAULO MELO DE SOUZA ◽  
ANDRÉ FLAVIO FREIRE PEREIRA ◽  
TULIO ALBUQUERQUE DE MOURA RANGEL ◽  
RODRIGO CASTRO DE MEDEIROS ◽  
LUCIANO TEMPORAL BORGES CABRAL ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Supine Position ◽  
Thoracic Curve ◽  
Reference Standard ◽  
Lumbar Curve ◽  
Level Of Evidence ◽  
Main Thoracic ◽  
Significant Difference ◽  
The Mean

ABSTRACT Objective To determine if there is a statistically significant difference in the flexibility of the curves in the adolescent idiopathic scoliosis (AIS) by using lateral inclination radiographs in supine or prone decubitus. Methods We evaluated 19 patients with AIS, waiting for surgery. Radiographs of the patients were performed in orthostatic anteroposterior incidences and right and left lateral inclinations in prone and supine decubitus. The comparison between prone and supine decubitus was performed through the flexibility rates of the curves measured in each position. Results The mean flexibility rates measured in lateral inclination radiographs with the patient in the supine position were 54.4% ± 38.8% in the proximal thoracic curve, 45.8% ± 15.6% in the main thoracic curve, and 80.5% ± 20.7% in the thoracolumbar / lumbar curve. When the lateral inclination radiographs were performed with the patient in the prone position, we observed mean flexibility rates of 66.4% ± 34.3% in the proximal thoracic curve, 50.1% ± 12.8% in the main thoracic curve, and 80.6% ± 19.0% in the thoracolumbar / lumbar curve. Conclusion This present study did not find a statistically significant difference between the flexibility rates of the curves in the prone and supine positions, suggesting that the two radiographic methods analyzed are similar in the evaluation of the flexibility of the curves in adolescent idiopathic scoliosis. Level of evidence II; Development of diagnostic criteria in consecutive patients (with “gold” reference standard applied).

scholarly journals Effect of Direct Vertebral Rotation on the Uninstrumented Lumbar Curve in Thoracic Adolescent Idiopathic Scoliosis

2017 ◽  
Vol 11 (1) ◽  
pp. 127-137 ◽  
Author(s):  
Sung-Soo Kim ◽  
Jung-Hoon Kim ◽  
Se-Il Suk
Keyword(s):  
Retrospective Study ◽  
Lumbar Spine ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Group Versus ◽  
Vertebral Rotation ◽  
Lumbar Curve ◽  
Spontaneous Correction ◽  
Lowest Instrumented Vertebra ◽  
Coronal Correction

<sec><title>Study Design</title><p>Retrospective study.</p></sec><sec><title>Purpose</title><p>To determine the effect and direction of direct vertebral rotation (DVR) in the lowest instrumented vertebra (LIV) on the uninstrumented lumbar curve depending on the lumbar modifier used for the correction of thoracic adolescent idiopathic scoliosis.</p></sec><sec><title>Overview of Literature</title><p>DVR in the LIV should be implemented in a different direction to obtain better spontaneous lumbar correction depending on the preoperative lumbar spine modifier.</p></sec><sec><title>Methods</title><p>We retrospectively analyzed 160 patients with thoracic adolescent idiopathic scoliosis treated by pedicle screw instrumentation and rod derotation. Patients who had a distal fusion level between T11 and L1 were divided into two groups: the DVR group versus the No-DVR group. Each group was divided into subgroups depending on the lumbar modifier used: the DVR-A, B, and C groups versus the No-DVR-A, B, and C groups. The DVR-A group was subdivided into two subgroups depending on the direction of screw rotation in the LIV: the DVR-A-O group (opposite direction) and the DVR-A-S group (same direction).</p></sec><sec><title>Results</title><p>There were no significant differences in the preoperative curve characteristics between the two groups. The preoperative lumbar curve was corrected in 70% of the patients in the DVR group and in 56% in the No-DVR group. Spontaneous coronal correction of the lumbar curve was better in the DVR-A-S group than that in the No-DVR-A group. However, the DVR-A-O group had the higher incidence of adding-on deformity. The DVR-B and C groups showed better spontaneous correction of lumbar coronal magnitude, apical vertebral translation, and rotation and the LIV tilting.</p></sec><sec><title>Conclusions</title><p>In lumbar modifiers B and C, screws in the LIV have to be rotated opposite to the direction of the screw rotation of the main thoracic curve; however, in modifier A, the screws have to be rotated in the same direction.</p></sec>

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

Biomedika ◽  
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

Upper instrumented vertebra to the right of the lowest instrumented vertebra as a predictor of an increase in the main thoracic curve after selective posterior fusion for the thoracolumbar/lumbar curve in Lenke type 5C adolescent idiopathic scoliosis: multicenter study on the relationship between fusion area and surgical outcome

2019 ◽  
Vol 31 (6) ◽  
pp. 857-864 ◽  
Author(s):  
Hiroki Oba ◽  
Jun Takahashi ◽  
Sho Kobayashi ◽  
Tetsuro Ohba ◽  
Shota Ikegami ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Posterior Fusion ◽  
Main Thoracic ◽  
Lowest Instrumented Vertebra ◽  
Line Tilt ◽  
The Right ◽  
Upper Instrumented Vertebra

OBJECTIVEUnfused main thoracic (MT) curvatures occasionally increase after selective thoracolumbar/lumbar (TL/L) fusion. This study sought to identify the predictors of an unacceptable increase in MT curve (UIMT) after selective posterior fusion (SPF) of the TL/L curve in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS).METHODSForty-eight consecutive patients (44 females and 4 males, mean age 15.7 ± 2.5 years, range 13–24 years) with Lenke type 5C AIS who underwent SPF of the TL/L curve were analyzed. The novel “Shinshu line” (S-line) was defined as a line connecting the centers of the concave-side pedicles of the upper instrumented vertebra (UIV) and lowest instrumented vertebra (LIV) on preoperative radiographs. The authors established an S-line tilt to the right as S-line positive (S-line+, i.e., the UIV being to the right of the LIV) and compared S-line+ and S-line− groups for thoracic apical vertebral translation (T-AVT) and MT Cobb angle preoperatively, early postoperatively, and at final follow-up. The predictors for T-AVT > 20 mm at final follow-up were evaluated as well. T-AVT > 20 mm was defined as a UIMT.RESULTSAmong the 48 consecutively treated patients, 26 were S-line+ and 22 were S-line−. At preoperative, early postoperative, and final follow-up a minimum of 2 years later, the mean T-AVT was 12.8 mm (range −9.3 to 32.8 mm), 19.6 mm (range −13.0 to 41.0 mm), and 22.8 mm (range −1.9 to 68.7 mm) in the S-line+ group, and 10.8 mm (range −5.1 to 27.3 mm), 16.2 mm (range −11.7 to 42.1 mm), and 11.0 mm (range −6.3 to 26.9 mm) in the S-line− group, respectively. T-AVT in S-line+ patients was significantly larger than that in S-line− patients at the final follow-up. Multivariate analysis revealed S-line+ (odds ratio [OR] 23.8, p = 0.003) and preoperative MT Cobb angle (OR 7.9, p = 0.001) to be predictors of a UIMT.CONCLUSIONSS-line+ was defined as the UIV being to the right of the LIV. T-AVT in the S-line+ group was significantly larger than in the S-line− group at the final follow-up. S-line+ status and larger preoperative MT Cobb angle were independent predictors of a UIMT after SPF for the TL/L curve in patients with Lenke type 5C AIS. Surgeons should consider changing the UIV and/or LIV in patients exhibiting S-line+ during preoperative planning to avoid a possible increase in MT curve and revision surgery.

Preoperative pelvic obliquity: possible relation to postoperative coronal decompensation in thoracolumbar/lumbar adolescent idiopathic scoliosis

2021 ◽  
pp. 1-10
Author(s):  
Tomohiro Banno ◽  
Yu Yamato ◽  
Hiroki Oba ◽  
Tetsuro Ohba ◽  
Tomohiko Hasegawa ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Clinical Outcomes ◽  
Pelvic Obliquity ◽  
Posterior Fusion ◽  
Lumbar Curve ◽  
Fusion Surgery ◽  
The Right ◽  
Coronal Decompensation

OBJECTIVE Pelvic obliquity is frequently observed in patients with adolescent idiopathic scoliosis with thoracolumbar/lumbar (TL/L) curve. This study aimed to assess pelvic obliquity changes and their effects on clinical outcomes of posterior fusion surgery. METHODS Data in 80 patients (69 with type 5C and 11 with type 6C adolescent idiopathic scoliosis) who underwent posterior fusion surgery were retrospectively analyzed. Pelvic obliquity was defined as an absolute pelvic obliquity angle (POA) value of ≥ 3°. The patients were divided into groups according to preoperative pelvic obliquity. Moreover, patients with preoperative pelvic obliquity were divided based on POA change from preoperative values versus 2 years postoperatively. Patients were divided based on the presence of selective or nonselective TL/L fusion. Radiographic parameters and clinical outcomes were compared between these groups. RESULTS Among 80 patients, 41 (51%) showed preoperative pelvic obliquity, and its direction was upward to the right for all cases. Coronal decompensation 2 years postoperatively was significantly elevated in patients with preoperative pelvic obliquity (p < 0.05). Thirty-two patients (40%) displayed pelvic obliquity 2 years postoperatively. Among 41 patients with preoperative pelvic obliquity, 22 patients (54%) were in the group with a decrease in POA, and 19 were in the group with no decrease. The group with no decrease in POA showed significant TL/L curve progression throughout the postoperative follow-up period. The patients with nonselective fusion showed a significantly lower incidence of pelvic obliquity at 2 years postoperatively. CONCLUSIONS Postoperative coronal decompensation more frequently occurred in patients with preoperative pelvic obliquity than in those without pelvic obliquity preoperatively. In addition, postoperative pelvic obliquity changes may be related to residual lumbar curve behavior.

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