scholarly journals Cervical sagittal alignment and the impact of posterior spinal instrumented fusion in patients with Lenke type 1 adolescent idiopathic scoliosis

2018 ◽  
Vol 4 (2) ◽  
pp. 342-348
Author(s):  
Ryan J. Berger ◽  
Assem A. Sultan ◽  
Joseph E. Tanenbaum ◽  
William A. Cantrell ◽  
David P. Gurd ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Sagittal Alignment ◽  
Instrumented Fusion ◽  
Cervical Sagittal Alignment ◽  
The Impact

scholarly journals Normal Age-Adjusted Sagittal Spinal Alignment Is Achieved with Surgical Correction in Adolescent Idiopathic Scoliosis

2017 ◽  
Vol 11 (5) ◽  
pp. 770-779 ◽  
Author(s):  
Subaraman Ramchandran ◽  
Norah Foster ◽  
Akhila Sure ◽  
Thomas J. Errico ◽  
Aaron J. Buckland
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pelvic Incidence ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Surgical Correction ◽  
Sagittal Vertical Axis

<sec><title>Study Design</title><p>Retrospective analysis.</p></sec><sec><title>Purpose</title><p>Our hypothesis is that the surgical correction of adolescent idiopathic scoliosis (AIS) maintains normal sagittal alignment as compared to age-matched normative adolescent population.</p></sec><sec><title>Overview of Literature</title><p>Sagittal spino-pelvic alignment in AIS has been reported, however, whether corrective spinal fusion surgery re-establishes normal alignment remains unverified.</p></sec><sec><title>Methods</title><p>Sagittal profiles and spino-pelvic parameters of thirty-eight postsurgical correction AIS patients ≤21 years old without prior fusion from a single institution database were compared to previously published normative age-matched data. Coronal and sagittal measurements including structural coronal Cobb angle, pelvic incidence, pelvic tilt, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, C2–C7 cervical lordosis, C2–C7 sagittal vertical axis, and T1 pelvic angles were measured on standing full-body stereoradiographs using validated software to compare preoperative and 6 months postoperative changes with previously published adolescent norms. A sub-group analysis of patients with type 1 Lenke curves was performed comparing preoperative to postoperative alignment and also comparing this with previously published normative values.</p></sec><sec><title>Results</title><p>The mean coronal curve of the 38 AIS patients (mean age, 16±2.2 years; 76.3% female) was corrected from 53.6° to 9.6° (80.9%, <italic>p</italic>&lt;0.01). None of the thoracic and spino-pelvic sagittal parameters changed significantly after surgery in previously hypo- and normo-kyphotic patients. In hyper-kyphotic patients, thoracic kyphosis decreased (<italic>p</italic>=0.003) with a reciprocal decrease in lumbar lordosis (<italic>p</italic>=0.01), thus lowering pelvic incidence-lumbar lordosis mismatch mismatch (<italic>p</italic>=0.009). Structural thoracic scoliosis patients had slightly more thoracic kyphosis than age-matched patients at baseline and surgical correction of the coronal plane of their scoliosis preserved normal sagittal alignment postoperatively. A sub-analysis of Lenke curve type 1 patients (n=24) demonstrated no statistically significant changes in the sagittal alignment postoperatively despite adequate coronal correction.</p></sec><sec><title>Conclusions</title><p>Surgical correction of the coronal plane in AIS patients preserves sagittal and spino-pelvic alignment as compared to age-matched asymptomatic adolescents.</p></sec>

scholarly journals Cervical sagittal alignment in patients with adolescent idiopathic scoliosis: is it corrected by surgery?

2018 ◽  
Vol 21 (3) ◽  
pp. 292-301 ◽  
Author(s):  
Jae Hwan Cho ◽  
Chang Ju Hwang ◽  
Young Hyun Choi ◽  
Dong-Ho Lee ◽  
Choon Sung Lee
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Clinical Outcomes ◽  
Thoracic Kyphosis ◽  
Sagittal Alignment ◽  
Corrective Surgery ◽  
Related Factors ◽  
Radiological Parameter ◽  
Number Of Patients ◽  
Cervical Sagittal Alignment

OBJECTIVECervical sagittal alignment (CSA) is related to function and quality of life, but it has not been frequently studied in patients with adolescent idiopathic scoliosis. This study aimed to reveal the change in CSA following corrective surgery, compare the cervical sagittal parameters according to curve types, and assess related factors for postoperative aggravation of CSA.METHODSThe authors studied 318 consecutive patients with adolescent idiopathic scoliosis who underwent corrective surgery at a single center. Occiput–C2 and C2–7 lordosis, C2–7 sagittal vertical axis (SVA), T-1 slope, thoracic kyphosis, and lumbar sagittal profiles were measured preoperatively and postoperatively. Scoliosis Research Society Outcomes Questionnaire (SRS-22) scores were used as clinical outcomes. Each radiological parameter was compared preoperatively and postoperatively according to curve types (double major, single thoracic, and double thoracic curves). Patients were grouped based on preoperative CSA: the lordotic group (group L) and the kyphotic group (group K). Each radiological parameter was compared between the groups. Related factors for postoperative aggravation of CSA were assessed using multivariate logistic analysis.RESULTSOf the total number of patients studied, 67.0% (213 of 318) and 54.4% (173 of 318) showed cervical kyphotic alignment preoperatively and postoperatively, respectively. C2–7 lordosis increased (from −5.8° to −1.1°; p < 0.001) and C2–7 SVA decreased (from 24.2 to 20.0 mm; p < 0.001) postoperatively regardless of curve types. Although group K showed improvement in C2–7 lordosis (from −12.7° to −4.8°; p < 0.001), group L showed no difference (from 9.0° to 6.9°; p = 0.115) postoperatively. Clinical outcomes were not related to the degree of cervical kyphosis in this cohort. C2–7 lordosis (p < 0.001) and pelvic tilt (p = 0.019) were related to postoperative aggravation of CSA.CONCLUSIONSRegardless of the trend of improvement in CSA, many patients (54.4%) still showed cervical kyphotic alignment postoperatively. C2–7 lordosis and C2–7 SVA improved postoperatively in all curve types. However, postoperative changes in C2–7 lordosis showed different results based on preoperative CSA, which could be related to T-1 slope and thoracic kyphosis. However, clinical outcomes showed no difference based on CSA in this study cohort. Greater C2–7 lordosis and proximal thoracic curve preoperatively were risk factors for postoperative aggravation of CSA (p < 0.001 and p = 0.019, respectively).

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