Changes of Upper Thoracic Curve and Shoulder Balance in Thoracic Adolescent Idiopathic Scoliosis Treated by Anterior Selective Thoracic Fusion Using VATS

Object In the surgical management of adolescent idiopathic scoliosis (AIS), patients are often preoperatively informed that they will gain height as a result of their surgery. However, current estimations conflict significantly and do not have any clinical correlation. The authors developed a formula that would predict postoperative gains in height after deformity correction in AIS. Methods A large, multicenter, prospective database was retrospectively queried for AIS patients with Lenke Type 1, 2, or 3 curves having undergone posterior spinal fusion alone. A univariate and multivariate analysis was performed to identify which factors contributed significantly to changes in height. Results Four hundred forty-seven patients were included in the series. Factors correlating with changes in postoperative height included: upper thoracic curve magnitude, main thoracic curve magnitude, lumbar curve magnitude, T2–12 kyphosis, T5–12 kyphosis, curve flexibility, number of levels fused, presence of Ponte osteotomies, total preoperative coronal Cobb angle, change in coronal curve magnitude, total preoperative sagittal curvature, change in sagittal curvature, and thoracic curve correction. When combined in a multivariate regression analysis the following variables remained significant: thoracic curve magnitude (p < 0.01), number of levels fused (p < 0.01), change in total sagittal curvature (p < 0.01), and the presence of osteotomies (p = 0.03). The contribution from the thoracic curve magnitude was significantly greater than any of the other parameters identified (R2 = 0.140). Change in height (in cm) = ([thoracic curve magnitude × 0.039] + [number of levels fused × 0.193] − [change in sagittal curvature × 0.033] + [x × 0.375]) − 1.858, where x = 1 if 1 or more osteotomies were performed and x = 0 if no osteotomy was performed. Conclusions The authors' results suggest that changes in the coronal plane contribute more significantly to height changes than those in the sagittal plane and approximately 0.39 cm of height gain can be expected for each 10° of coronal curve preoperatively. Unfortunately, a significant fraction of the postoperative height changes cannot be predicted by currently measured parameters.

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A preoperative radiological measurement that can predict poor results after a selective thoracic fusion (STF) in patients with adolescent idiopathic scoliosis (AIS)

The Spine Journal ◽

10.1016/j.spinee.2015.12.040 ◽

2016 ◽

Vol 16 (4) ◽

pp. S99

Author(s):

Amy Lambert ◽

Ashley Cole ◽

Lee Breakwell ◽

A.L. Rex Michael

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Selective Thoracic Fusion ◽

Radiological Measurement

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Shoulder Balance Following Correction Surgery for Adolescent Idiopathic Scoliosis

Clinical Spine Surgery ◽

10.1097/bsd.0000000000001154 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Vikaesh Moorthy ◽

Graham S. Goh ◽

Chang-Ming Guo ◽

Seang-Beng Tan ◽

John Li-Tat Chen ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Shoulder Balance ◽

Correction Surgery

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What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis?

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.10.peds20671 ◽

2021 ◽

pp. 1-7

Author(s):

M. Omar Iqbal ◽

Amer F. Samdani ◽

Joshua M. Pahys ◽

Peter O. Newton ◽

Suken A. Shah ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Univariate Analysis ◽

Posterior Spinal Fusion ◽

Research Society ◽

Curve Correction ◽

Scoliosis Research Society ◽

Lenke Classification ◽

Upper Instrumented Vertebra ◽

Upper Thoracic

OBJECTIVE Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS. METHODS The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1–4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)–22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model. RESULTS The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement. CONCLUSIONS Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1–4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.

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Comparison of Shoulder Balance between Rod Derotation and Rod Derotation with Direct Vertebral Rotation in Double Thoracic Adolescent Idiopathic Scoliosis

Global Spine Journal ◽

10.1055/s-0035-1554360 ◽

2015 ◽

Vol 5 (1_suppl) ◽

pp. s-0035-1554360-s-0035-1554360

Author(s):

Dong-Gune Chang ◽

Jin-Hyok Kim ◽

Kee-Yong Ha ◽

Dong-Ju Lim ◽

Se-Il Suk

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Vertebral Rotation ◽

Shoulder Balance

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The recognition and modelling of a backbone and its deformity

Nonlinear Analysis Modelling and Control ◽

10.15388/na.2014.1.4 ◽

2014 ◽

Vol 19 (1) ◽

pp. 55-66

Author(s):

Ramūnas Markauskas ◽

Algimantas Juozapavičius ◽

Kęstutis Saniukas ◽

Giedrius Bernotavičius

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Input Data ◽

Thoracic Curve ◽

Line Centre ◽

High Quality ◽

Radiographic Images ◽

Initial Curvature ◽

Curvature Detection ◽

Quality Features

In this article the authors present a method for the backbone recognition and modelling. The process of recognition combines some classical techniques (Hough transformation, GVF snakes) with some new (authors present a method for initial curvature detection, which they call the Falling Ball method). The result enables us to identify high-quality features of the spine and to detect the major deformities of backbone: the intercrestal line, centre sacral vertical line, C7 plumbline; as well as angles: proximal thoracic curve, main thoracic curve, thoracolumbar/lumbar. These features are used for measure in adolescent idiopathic scoliosis, especially in the case of treatment. Input data are just radiographic images, meet in everyday practice.

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