Postoperative changes in sagittal spinopelvic alignment in sitting position in adolescents with idiopathic thoracic scoliosis treated with posterior fusion: an initial analysis

OBJECTIVEPrevious studies have reported spinal straightening and pelvic retroversion when changing from erect to sitting posture in patients with adolescent idiopathic scoliosis (AIS), which were thought to be related to low-back pain after sitting for long periods. However, the sitting sagittal alignment after posterior spinal fusion has not been evaluated. This study aims to assess the influence of posterior fusion surgery upon sitting sagittal spinopelvic alignment in adolescents with idiopathic thoracic curves (thoracic AIS [T-AIS]).METHODSA total of 44 T-AIS patients (30 Lenke I and 14 Lenke II) from the authors’ center were included in this study. Preoperative and postoperative long-cassette lateral radiographs of the spine and pelvis were obtained with the patients in standing and sitting positions. Thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured on standing and sitting lateral radiographs. Patients were divided into selective thoracic fusion (STF) and nonselective thoracic fusion (NSTF) groups.RESULTSAt baseline, TK, LL, and SS decreased by 27.5%, 42.1%, and 31.1%, respectively, from the standing to the sitting position, while PT increased by 193.6%. After posterior spinal fusion, increased TK, LL, and SS and corresponding decreased PT were observed compared to baseline parameters in the sitting position. Comparison of postoperative sitting and standing values for the whole cohort showed that the mean LS and SS values were significantly lower in the sitting position (decreased by 14.0% and 13.9%, respectively, compared to standing), whereas the mean PT value was significantly greater (increased by 39.0%, compared to standing). Similar changes were also observed in the STF group: postoperatively the mean LL value was 15.6% lower in sitting than in standing, while the mean SS value was 11.5% lower. However, no obvious changes of the postoperative values in sitting were found in the NSTF group.CONCLUSIONSNonselective thoracic fusion surgery in T-AIS patients diminished spinal straightening and pelvic retroversion during sitting. Reducing distal fusion levels was of special value in not only saving more lumbar mobility, but also preserving the function of pelvic posterior rotation.

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What trajectory is safe for double penetrating endplate screw posterior spinal fusion surgery in the thoraco-lumbar region?

World Neurosurgery ◽

10.1016/j.wneu.2021.05.027 ◽

2021 ◽

Author(s):

Hisanori Gamada ◽

Masao Koda ◽

Itsuo Shina ◽

Tomoyuki Asada ◽

Fumihiko Eto ◽

...

Keyword(s):

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Lumbar Region ◽

Fusion Surgery ◽

Spinal Fusion Surgery

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Fatal pulmonary fat embolism after posterior spinal fusion surgery

Journal of Orthopaedic Science ◽

10.1007/s00776-005-0992-7 ◽

2006 ◽

Vol 11 (2) ◽

pp. 217-220 ◽

Cited By ~ 2

Author(s):

Yoshimasa Takahashi ◽

Ken’ichiro Narusawa ◽

Kenji Shimizu ◽

Masakazu Takata ◽

Toshitaka Nakamura

Keyword(s):

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Fat Embolism ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Pulmonary Fat Embolism

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Standardization of lateral pelvic radiograph is necessary to predict spinopelvic mobility accurately

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2019-1548.r1 ◽

2020 ◽

Vol 102-B (7_Supple_B) ◽

pp. 41-46 ◽

Cited By ~ 1

Author(s):

Michael Ransone ◽

Keith Fehring ◽

Thomas Fehring

Keyword(s):

Pelvic Tilt ◽

Preoperative Planning ◽

Sacral Slope ◽

Sitting Posture ◽

Sit To Stand ◽

Pelvic Radiograph ◽

Increased Risk ◽

Anterior Pelvic Tilt ◽

B 41 ◽

The Mean

Aims Patients with abnormal spinopelvic mobility are at increased risk for instability. Measuring the change in sacral slope (ΔSS) can help determine spinopelvic mobility preoperatively. Sacral slope (SS) should decrease at least 10° to demonstrate adequate posterior pelvic tilt. There is potential for different ΔSS measurements in the same patient based on sitting posture. The purpose of this study was to determine the effect of sitting posture on the ΔSS in patients undergoing total hip arthroplasty (THA). Methods In total, 51 patients undergoing THA were reviewed to quantify the variability in preoperative spinopelvic mobility when measuring two different sitting positions using SS for planning. Results A total of 32 patients had standardized relaxed sitting radiographs, while 35 patients had standardized flexed sitting images. Of the 32 patients with relaxed sitting views, the mean ΔSS was 20.7° (SD 8.9°). No patients exhibited an increase in SS during relaxed sitting (i.e. anterior pelvic tilt or so-called reverse accommodation). Of the 35 patients with flexed sitting radiographs, the mean ΔSS was only 2.1° (SD 9.7°) with 16/35 (45.71%) showing anterior pelvic tilt, or so-called reverse accommodation, unexpectedly increasing the sitting SS compared to the standing SS. Overall, 18 patients had both relaxed sitting and flexed sitting radiographs. In patients with both types of sitting radiographs, the mean relaxed sit to stand ΔSS was 18.06° (SD 6.07°), while only a 3.00° (SD 10.53°) ΔSS was noted when flexed sitting. There was a mean ΔSS difference of 15.06° (SD 7.67°) noted in the same patient cohort depending on sitting posture (p < 0.001). Conclusion A 15° mean difference was noted depending on the sitting posture of the patient. Since decisions on component position can be made on preoperative lateral sit-stand radiographs, postural standardization is crucial. If using ΔSS for preoperative planning, the relaxed sitting radiograph is preferred. Cite this article: Bone Joint J 2020;102-B(7 Supple B):41–46.

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Comparison of 2 Methods of Incision Closure in Patients With Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion Surgery

Spine ◽

10.1097/brs.0000000000000223 ◽

2014 ◽

Vol 39 (8) ◽

pp. E481-E485 ◽

Cited By ~ 5

Author(s):

Leilei Xu ◽

Feng Zhu ◽

Zezhang Zhu ◽

Zhen Liu ◽

Xu Sun ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Fusion Surgery ◽

Spinal Fusion Surgery

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Variations of Sagittal Alignment in Standing Versus Sitting Positions Under the Roussouly Classification in Asymptomatic Subjects

Global Spine Journal ◽

10.1177/2192568220962436 ◽

2020 ◽

pp. 219256822096243

Author(s):

Zhuoran Sun ◽

Siyu Zhou ◽

Shuai Jiang ◽

Da Zou ◽

Miao Yu ◽

...

Keyword(s):

Sacral Slope ◽

Healthy Population ◽

Sitting Position ◽

Spinopelvic Alignment ◽

Roussouly Classification ◽

Asymptomatic Subjects ◽

Type 3 ◽

Parameter Values

Study Design: Prospective radiological analysis. Objective: To investigate the characteristics of the sagittal spinopelvic alignment in the standing and sitting positions under the Roussouly classification in a healthy population. Methods: This study using standing and sitting lateral radiographs included 143 volunteers whose spinopelvic parameters were measured. The parameters were compared in the standing and sitting positions. The lumbo-pelvic profile was identified according to the Roussouly classification. The differences in the values of the parameters between the standing and sitting positions were analyzed. The different frequencies of the unchanged apex were assessed. Results: All parameter values except the thoracolumbar angle (TLK) were significantly altered. With regard to the classification of the lumbopelvic profile, 15 (10.5%) subjects were excluded because they were evaluated as not belonging to any of the Roussouly types. The remaining 128 subjects were evaluated and classified as follows: 19 (14.8%), type 1; 53 (41.4%), type 2; 9 (7.0%), type 3 + anteverted pelvis (AP); 33 (25.8%), type 3; and 14 (10.9%), type 4. The differences in the pelvic tilt (PT), sacral slope (SS), and thoracic pelvic angle (TPA) values were significantly lower in types 1 and 2 than in other Roussouly types. Corresponding variations in the apical vertebra for the sagittal lumbar curves in the sitting position were observed. Conclusions: Subjects with Roussouly type 1 and type 2 sagittal alignments were found to be less capable of performing changes in alignment when changing to the sitting position. The characteristics of the apical movement were also different.

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Three-dimensional Computed Tomography for Assessing Lung Morphology in Adolescent Idiopathic Scoliosis following Posterior Spinal Fusion Surgery

Orthopaedic Surgery ◽

10.1111/os.12151 ◽

2015 ◽

Vol 7 (1) ◽

pp. 43-49 ◽

Cited By ~ 5

Author(s):

Jun Fu ◽

Chao Liu ◽

Yong-gang Zhang ◽

Guo-quan Zheng ◽

Guo-ying Zhang ◽

...

Keyword(s):

Computed Tomography ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Three Dimensional ◽

Posterior Spinal Fusion ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Lung Morphology

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A Randomized, Double-Blind, Placebo-Controlled Safety and Efficacy Study of a Four-Antigen Vaccine for Staphylococcus Aureus in Adults Prior to Open Posterior Spinal Fusion Surgery

The Spine Journal ◽

10.1016/j.spinee.2017.08.070 ◽

2017 ◽

Vol 17 (10) ◽

pp. S206-S207 ◽

Cited By ~ 1

Author(s):

Michael Y. Wang ◽

Gustavo Dayan ◽

Hamid Hassanzadeh ◽

Jean-Charles Le Huec ◽

Vikas V. Patel ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Efficacy Study ◽

Double Blind ◽

Fusion Surgery ◽

Safety And Efficacy ◽

Double Blind Placebo ◽

Spinal Fusion Surgery ◽

Antigen Vaccine

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Intranasal Premedication Combined with Erector Spinae Plane Block during Spinal Surgery for a Paediatric Patient: A Case Report

Austin - Critical Care Journal ◽

10.26420/austincritcarej.2021.1037 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Bao L ◽

◽

Qu M ◽

Jing S ◽

◽

...

Keyword(s):

Spinal Fusion ◽

Spinal Surgery ◽

Congenital Scoliosis ◽

Posterior Spinal Fusion ◽

Erector Spinae ◽

Surgical Trauma ◽

Fusion Surgery ◽

Perioperative Analgesia ◽

Spinal Fusion Surgery ◽

Erector Spinae Plane Block

Posterior spinal fusion surgery for congenital scoliosis may cause substantial surgical trauma. Erector Spinae Plane Block (ESPB) can alleviate pain in adults who undergo spinal surgery; however, reports regarding its use in paediatric patients are limited. Here, we report the case of a 2-year-old girl who underwent posterior spinal fusion for congenital scoliosis. The patient initially experienced severe sadness upon separation from her parents; however, after performing various interactive activities, premedication using intranasal dexmedetomidine and midazolam was administered to sedate the patient. Ultrasound-guided bilateral ESPB was applied for perioperative analgesia. The anaesthesiologist identified mild-to-moderate pain during the first 6 days after surgery using the visual analogue scale for pain and Face, Legs, Activity, Cry, and Consolability scale. Therefore, ESPB may provide a satisfactory analgesic effect and help reduce postoperative opioid consumption in children who require spinal fusion surgery.

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