Patterns of coronal and sagittal deformities in adolescent idiopathic scoliosis

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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Patterns of coronal and sagittal deformities in adolescent idiopathic scoliosis

10.21203/rs.3.rs-42561/v2 ◽

2020 ◽

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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Patterns of Coronal and Sagittal Deformities in Adolescent Idiopathic Scoliosis

10.21203/rs.3.rs-42561/v1 ◽

2020 ◽

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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Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

Scientific Reports ◽

10.1038/s41598-020-79523-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Laura Scaramuzzo ◽

Antonino Zagra ◽

Giuseppe Barone ◽

Stefano Muzzi ◽

Leone Minoia ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Thoracic Kyphosis ◽

Sagittal Alignment ◽

Vertical Axis ◽

Sagittal Profile ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

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ROLE OF DIFFERENT HORMONES IN THE PATHOGENESIS AND SEVERITY OF ADOLESCENT IDIOPATHIC SCOLIOSIS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172501168600 ◽

2017 ◽

Vol 25 (1) ◽

pp. 15-17 ◽

Cited By ~ 4

Author(s):

RICARDO TEIXEIRA E SILVA ◽

RENAN JOSE RODRIGUES FERNANDES ◽

ALLAN HIROSHI DE ARAÚJO ONO ◽

RAPHAEL MARTUS MARCON ◽

ALEXANDRE FOGAÇA CRISTANTE ◽

...

Keyword(s):

Quality Of Life ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Inverse Correlation ◽

Serum Levels ◽

Diagnostic Study ◽

Level Of Evidence ◽

Hydroxyvitamin D

ABSTRACT Objective: To evaluate the hormonal profile of patients with adolescent idiopathic scoliosis (AIS) and its relationship to the severity of the curvature and quality of life . Method: Patients with scoliosis (Cobb angle above 10°), of both genders, diagnosed after 10 years of age were included, excluding those who presented other condition that could lead to scoliosis. Serum levels of 25-hydroxyvitamin D (25-OHD), cortisol and gastrin were correlated with Cobb angle and quality of life, measured by the SRS-30 questionnaire . Results: The levels of 25-OHD decreased in 97% of patients. There was an inverse relationship between gastrin levels and quality of life (p = 0.016). Moreover, there was an inverse correlation between the value of Cobb angle and quality of life (p = 0.036). There were no changes in cortisol levels. There was no correlation between Cobb angle and any of the hormones measured . Conclusion: The patients had levels of 25-OHD diminished, strengthening the hypothesis of its involvement in the development of AIS. This study also suggests that increased gastrin levels may be associated with a worse quality of life in patients with AIS. Level of Evidence II, Diagnostic Study.

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Effectiveness of Scoliosis-Specific Exercises for Alleviating Adolescent Idiopathic Scoliosis: A Systematic Review

10.21203/rs.3.rs-32734/v1 ◽

2020 ◽

Author(s):

Yunli Fan ◽

Qing Ren ◽

Michael KT TO ◽

Jason Pui Yin Cheung

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Skeletal Maturity ◽

Controlled Trials ◽

Insufficient Evidence ◽

Curve Magnitude ◽

Exercise Compliance ◽

Maturity Curve

Abstract Background Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal deformity with reported complications including pain, mental health concern and respiratory dysfunction. The Scoliosis-specific exercise (SSE) is prescribed throughout pubertal growth to slow progression although effects are unclear. This review aims to establish the effectiveness of SSE in alleviating AIS in terms of reducing Cobb angle, improving trunk asymmetry and quality of life (QoL). Additionally, it aims to define the effects of age, skeletal maturity, curve magnitude and exercise compliance on the outcomes of SSE. Methods A systematic reviewed was conducted to net SSE articles. Searched databases included PubMed, MEDLINE, Cochrane Library, Scopus, CINAHL and Google scholar. The quality of study was critically appraised according to the PEDro scale. Results A total of ten trials with an average PEDro score of 6.9/10 were examined in this study. Two randomized controlled trials (RCTs) and two clinical controlled trials suggested that SSE alone and with bracing or traditional exercise had clinical significance in reducing Cobb angle more than 5°. One RCT specifically implicated no comparable effects between bracing and SSE in prevention of curve progression for moderate scoliosis. Insufficient evidence demonstrated the positive effects of SSE in improving truck asymmetry (n = 4) and QoL (n = 3). Five studies evaluated the interaction effects of age (n = 2), skeletal maturity (n = 1) and curve magnitude (n = 2) with SSE in reducing Cobb angle yet without drawing any firm conclusions. Conclusions Insufficient evidence is available to prove that SSE with or without other conservative treatments can reduce Cobb angle, improve trunk balance and QoL. The interaction effects of age, skeletal maturity, curve magnitude, and exercise compliance with SSE in reducing Cobb angle are not proven. Future studies should investigate the relationship of influencing factors and SSE in treating AIS but not only testing its effectiveness.

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Reciprocal Changes in Sagittal Alignment in Adolescent Idiopathic Scoliosis Patients Following Strategic Pedicle Screw Fixation

Asian Spine Journal ◽

10.4184/asj.2018.12.2.300 ◽

2018 ◽

Vol 12 (2) ◽

pp. 300-308 ◽

Cited By ~ 2

Author(s):

Srikanth Reddy Dumpa ◽

Ajoy Prasad Shetty ◽

Siddharth N. Aiyer ◽

Rishi Mugesh Kanna ◽

S Rajasekaran

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Sagittal Profile ◽

Pelvic Parameters ◽

Screw Density ◽

Sagittal Parameters ◽

Coronal Correction

<sec><title>Study Design</title>Retrospective observational study.</sec><sec><title>Purpose</title>To analyze the effect of low-density (LD) strategic pedicle screw fixation on the correction of coronal and sagittal parameters in adolescent idiopathic scoliosis (AIS) patients.</sec><sec><title>Overview of Literature</title>LD screw fixation achieves favorable coronal correction, but its effect on sagittal parameters is not well established. AIS is often associated with decreased thoracic kyphosis (TK), and the use of multi-level pedicle screws may result in further flattening of the sagittal profile.</sec><sec><title>Methods</title>A retrospective analysis was performed on 92 patients with AIS to compare coronal and sagittal parameters preoperatively and at 2-year follow-up. All patients underwent posterior correction via LD strategic pedicle screw fixation. Radiographs were analyzed for primary Cobb angle (PCA), coronal imbalance, cervical sagittal angle (CSA), TK, lumbar lordosis (LL), pelvic incidence, pelvic tilt (PT), sacral slope (SS), C7 plumb line, spino-sacral angle, curve flexibility, and screw density.</sec><sec><title>Results</title>PCA changed significantly from 57.6°±13.9° to 19°±8.4° (<italic>p</italic> <0.0001) with 67% correction, where the mean curve flexibility was 41% and screw density was 68%. Regional sagittal parameters did not change significantly, including CSA (from 10.76° to 10.56°, <italic>p</italic> =0.893), TK (from 24.4° to 22.8°, <italic>p</italic> =0.145), and LL (from 50.3° to 51.1°, <italic>p</italic> =0.415). However, subgroup analysis of the hypokyphosis group (<10°) and the hyperkyphosis group (>40°) showed significant correction of TK (<italic>p</italic> <0.0001 in both). Sacro-pelvic parameters showed a significant decrease of PT and increase of SS, suggesting a reduction in pelvic retroversion SS (from 37° to 40°, <italic>p</italic> =0.0001) and PT (from 15° to 14°, <italic>p</italic> =0.025).</sec><sec><title>Conclusions</title>LD strategic pedicle screw fixation provides favorable coronal correction and improves overall sagittal sacro-pelvic parameters. This technique does not cause significant flattening of TK and results in a favorable restoration of TK in patients with hypokyphosis or hyperkyphosis.</sec>

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Novel questionnaire to enhance brace wear adherence in patients with adolescent idiopathic scoliosis and the relationship of the quality of life

Orthopedic Reviews ◽

10.4081/or.2021.8840 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Thamrong Lertudomphonwanit ◽

Nachapan Pengrung ◽

Chaiwat Kriwattanapong ◽

Chanika Angsanuntsukh ◽

Pittavat Leelapattana ◽

...

Keyword(s):

Quality Of Life ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Included Patient ◽

Nested Case Control ◽

The Relationship

Bracing is an effective non-operative treatment, in patients with adolescent idiopathic scoliosis (AIS). The relationship between patients’ quality of life (QOL) and brace wear adherence has been reported. This study aims to determine brace wear adherence for AIS patients with novel questionnaire. A nested case-control study was conducted, included patient age 10-18 years, coronal Cobb angle 20-50°, and Risser grade 0-3. Correlation between patients’ QOL and the average hours of daily brace-wear were determined. Patients were divided into 3 groups based on brace wear adherence and were compared. QOL domains associated with the incompleteness of brace-wearing were determined by Cox proportional-hazards regression. Mean age of patients was 13.3 years (range 11-17.3 years) with initial Cobb angle of 33.5° (range 20-48°). There were significant negative correlations between total QOL scores and brace wearing time. Increased social domain scores was significantly associated with less brace wearing time (HR 1.5, 95% CI 1.12-2.04). Significant correlations between patients’ QOL and the average hours per day of brace wear. Poor social QOL have a significant impact on brace wear adherence.

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What Is the Effect of Surgery on the Quality of Life of the Adolescent With Adolescent Idiopathic Scoliosis?

Spine ◽

10.1097/brs.0b013e3182837c95 ◽

2013 ◽

Vol 38 (9) ◽

pp. 786-794 ◽

Cited By ~ 21

Author(s):

Paul R. P. Rushton ◽

Michael P. Grevitt

Keyword(s):

Quality Of Life ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis

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Supine flexibility predicts curve progression for patients with adolescent idiopathic scoliosis undergoing underarm bracing

The Bone & Joint Journal ◽

10.1302/0301-620x.102b2.bjj-2019-0916.r1 ◽

2020 ◽

Vol 102-B (2) ◽

pp. 254-260 ◽

Cited By ~ 4

Author(s):

Jason P. Y. Cheung ◽

Prudence W. H. Cheung

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Regression Model ◽

Cobb Angle ◽

Characteristic Curve ◽

Absolute Error ◽

Curve Progression ◽

Curve Magnitude ◽

Spine Radiograph ◽

Whole Spine

Aims The aim of this study was to assess whether supine flexibility predicts the likelihood of curve progression in patients with adolescent idiopathic scoliosis (AIS) undergoing brace treatment. Methods This was a retrospective analysis of patients with AIS prescribed with an underarm brace between September 2008 to April 2013 and followed up until 18 years of age or required surgery. Patients with structural proximal curves that preclude underarm bracing, those who were lost to follow-up, and those who had poor compliance to bracing (<16 hours a day) were excluded. The major curve Cobb angle, curve type, and location were measured on the pre-brace standing posteroanterior (PA) radiograph, supine whole spine radiograph, initial in-brace standing PA radiograph, and the post-brace weaning standing PA radiograph. Validation of the previous in-brace Cobb angle regression model was performed. The outcome of curve progression post-bracing was tested using a logistic regression model. The supine flexibility cut-off for curve progression was analyzed with receiver operating characteristic curve. Results A total of 586 patients with mean age of 12.6 years (SD 1.2) remained for analysis after exclusion. The baseline Cobb angle was similar for thoracic major curves (31.6° (SD 3.8°)) and lumbar major curves (30.3° (SD 3.7°)). Curve progression was more common in the thoracic curves than lumbar curves with mean final Cobb angles of 40.5° (SD 12.5°) and 31.8° (SD 9.8°) respectively. This dataset matched the prediction model for in-brace Cobb angle with less mean absolute error in thoracic curves (0.61) as compared to lumbar curves (1.04). Reduced age and Risser stage, thoracic curves, increased pre-brace Cobb angle, and reduced correction and flexibility rates predicted increased likelihood of curve progression. Flexibility rate of more than 28% has likelihood of preventing curve progression with bracing. Conclusion Supine radiographs provide satisfactory prediction for in-brace correction and post-bracing curve magnitude. The flexibility of the curve is a guide to determine the likelihood for brace success. Cite this article: Bone Joint J 2020;102-B(2):254–260.

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