Spinal Alignments of Residual Lumbar Curve Affect Disc Degeneration after Spinal Fusion in Patients with Adolescent Idiopathic Scoliosis: Follow-up after 5 or More Years

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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Spinal fusion on adolescent idiopathic scoliosis patients with the level of L4 or lower can increase lumbar disc degeneration with sagittal imbalance 35 years after surgery

Spine Surgery and Related Research ◽

10.22603/ssrr.1.2016-0017 ◽

2017 ◽

Vol 1 (2) ◽

pp. 72-77 ◽

Cited By ~ 8

Author(s):

Tsutomu Akazawa ◽

Toshiaki Kotani ◽

Tsuyoshi Sakuma ◽

Shohei Minami ◽

Sumihisa Orita ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Disc Degeneration ◽

Lumbar Disc ◽

Sagittal Imbalance ◽

Lumbar Disc Degeneration

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Prediction of Spontaneous Lumbar Curve Correction After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Lenke Type 1 Curves

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000736 ◽

2019 ◽

Vol 32 (2) ◽

pp. E112-E116

Author(s):

Masashi Uehara ◽

Jun Takahashi ◽

Shota Ikegami ◽

Shugo Kuraishi ◽

Toshimasa Futatsugi ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Lumbar Curve ◽

Curve Correction

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Prediction of long-term postoperative results of disc wedge and vertebral tilt with intraoperative prone radiograph in posterior correction of thoracolumbar/lumbar curve in adolescent idiopathic scoliosis: a minimum 5-year follow-up

The Spine Journal ◽

10.1016/j.spinee.2021.09.002 ◽

2021 ◽

Author(s):

Choon Sung Lee ◽

Kun-Bo Park ◽

Chang Ju Hwang ◽

Jae Hwan Cho ◽

Dong-Ho Lee ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Lumbar Curve ◽

Postoperative Results ◽

Posterior Correction

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Six-year follow-up study on the effect of combined anterior and posterior spinal fusion on lung function and quality of life in young people with adolescent idiopathic scoliosis

Archives of Disease in Childhood ◽

10.1136/archdischild-2013-305739 ◽

2014 ◽

Vol 99 (10) ◽

pp. 922-926 ◽

Cited By ~ 6

Author(s):

D. S. Urquhart ◽

S. Gallella ◽

D. Gidaris ◽

E. Brady ◽

S. Blacklock ◽

...

Keyword(s):

Quality Of Life ◽

Adolescent Idiopathic Scoliosis ◽

Lung Function ◽

Young People ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Follow Up Study

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196. Longitudinal changes of the sagittal plane after posterior spinal fusion of adolescent idiopathic scoliosis in Lenke 5 and 6 from baseline to two-year follow-up

The Spine Journal ◽

10.1016/j.spinee.2019.05.213 ◽

2019 ◽

Vol 19 (9) ◽

pp. S95

Author(s):

Mostafa H. El Dafrawy ◽

Owoicho Adogwa ◽

Michael P. Kelly ◽

Suken A. Shah ◽

Randal R. Betz ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Sagittal Plane ◽

Posterior Spinal Fusion ◽

Longitudinal Changes

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04821-5 ◽

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.

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