Spontaneous Proximal Thoracic Curve Correction After Isolated Fusion of the Main Thoracic Curve in Adolescent Idiopathic Scoliosis

Spine ◽  
2001 ◽  
Vol 26 (18) ◽  
pp. 1966-1975 ◽  
Author(s):  
Timothy R. Kuklo ◽  
Lawrence G. Lenke ◽  
Douglas S. Won ◽  
Eric J. Graham ◽  
Fred A. Sweet ◽  
...  
2016 ◽  
Vol 29 (8) ◽  
pp. E434-E441 ◽  
Author(s):  
Jingfeng Li ◽  
Kenneth M.C. Cheung ◽  
Dino Samartzis ◽  
Anne K.B. Ganal-Antonio ◽  
Xiaodong Zhu ◽  
...  

Biomedika ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 74-80
Author(s):  
Anggita Tri Yurisworo ◽  
Bagas Widhiarso ◽  
Andhi Prijosedjati ◽  
Pamudji Utomo

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


2012 ◽  
Vol 17 (3) ◽  
pp. 212-219 ◽  
Author(s):  
Steven W. Hwang ◽  
Amer F. Samdani ◽  
Ben Wormser ◽  
Hari Amin ◽  
Jeff S. Kimball ◽  
...  

Object Pedicle screw fixation has been theorized to provide better correction of scoliotic deformity, but controversy over the benefits of pedicle screw–only constructs remains, and the longer-term impact of pedicle screw fixation as compared with hybrid constructs is unclear. In this study, a retrospective review of a prospectively collected database was conducted to determine the longer-term impact of pedicle screw fixation as compared with hybrid constructs in patients with adolescent idiopathic scoliosis (AIS). Methods The authors retrospectively reviewed a multicenter database of pediatric patients (ages ≤ 18) from 1995 to 2006 and identified 127 patients with Lenke Type 1–4 AIS curves with a minimum 5 years of follow-up. Patients were divided into 2 cohorts based on whether they had undergone pedicle screw fixation or fixation with hybrid constructs. Results The mean main thoracic curvature of 56.1° ± 13.0°, which corrected to 14.9° ± 9.3°, translated into a mean correction of 73% (p < 0.01). The curve was 19.4° ± 10.6° at 2-year follow-up and 20.5° ± 10.4° at 5 years. When comparing preoperative parameters between the groups, differences were noted in the magnitude of the main thoracic curve (p = 0.04), flexibility of the main thoracic curve (p = 0.02), coronal balance (p = 0.04), T2–12 kyphosis (p = 0.02), and sex (p = 0.02). The pedicle screw cohort had fewer spinal segments instrumented (p < 0.01), fewer anterior releases performed (p = 0.02), and fewer thoracoplasties performed (p < 0.01). By 5 years of follow-up, significant differences were apparent between the two cohorts with respect to upper thoracic curvature (p = 0.01), T2–12 (p = 0.02) and T5–12 (p = 0.02) kyphosis, lumbar lordosis (p < 0.01), and sagittal balance (p = 0.01). Conclusions Although some preoperative differences did exist, outcomes were comparable between hybrid and screw constructs at 2 and 5 years. However, hybrid constructs required more concurrent anterior releases and thoracoplasties to achieve similar results.


2018 ◽  
Vol 23 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Tetsuhiko Mimura ◽  
Jun Takahashi ◽  
Shota Ikegami ◽  
Shugo Kuraishi ◽  
Masayuki Shimizu ◽  
...  

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 ◽  
...  

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