Usefulness of anterior column release for segmental lordosis restoration in degenerative lumbar kyphosis

OBJECTIVE Three-column osteotomies (3COs) for surgical correction of lumbar kyphosis show a strong correction capacity, but this procedure carries high morbidity rates. The anterior column release (ACR) technique was developed as a less invasive procedure. In this study the authors aimed to evaluate sagittal alignment restoration using ACR and to determine factors that affect the degree of correction. METHODS This study included 36 patients (68 cases) who underwent ACR of more than one level for adult spinal deformity. Parameters for regional sagittal alignment included segmental lordosis (SL). The parameters for global sagittal alignment included pelvic incidence, lumbar lordosis, sacral slope, pelvic tilt, and sagittal vertical axis (SVA). In addition, the interdiscal height (IDH) and difference of interdiscal angle (DIDA) were measured to evaluate the stiffness of the vertebra segment. The changes in SL were evaluated after ACR and the change of global sagittal alignment was also determined. Factors such as the location of the ACR level, IDH, DIDA, cage height, and additional posterior column osteotomy (PCO) were analyzed for correlation with the degree of SL correction. RESULTS Thirty-six patients were included in this study. A total of 68 levels were operated with the ACR (8 levels at L2–3, 27 levels at L3–4, and 33 levels at L4–5). ACR was performed for 1 level in 10 patients, 2 levels in 20, and 3 levels in 6 patients (mean 1.9 ± 0.7 levels per patient). Mean follow-up duration was 27.1 ± 4.2 months. The mean SL of the total segment was 0.4° ± 7.2° preoperatively and increased by 15.3° ± 5.5° at the last follow-up (p < 0.001); thus, the mean increase of SL was 14.9° ± 8.1° per one ACR. Global sagittal alignment was also improved following SL restoration with SVA from 101.9 mm to 31.4 mm. The degree of SL correction was correlated with the location of ACR level (p = 0.041) and was not correlated with IDH, DIDA, cage height and additional PCO. CONCLUSIONS This study demonstrated that the mean correction angle of SL was 14.9 per one ACR. The degree of disc space collapse and stiffness of segment did not affect the degree of correction by ACR.

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Lumbar Level Significantly Influences Postoperative Global Sagittal Balance Following Pedicle Subtraction Osteotomy

Global Spine Journal ◽

10.1177/21925682211032563 ◽

2021 ◽

pp. 219256822110325

Author(s):

Athan G. Zavras ◽

T. Barrett Sullivan ◽

Navya Dandu ◽

Howard S. An ◽

Christopher J. DeWald ◽

...

Keyword(s):

Sagittal Balance ◽

Sagittal Alignment ◽

Adult Spinal Deformity ◽

Vertical Axis ◽

Pedicle Subtraction Osteotomy ◽

Current Evidence ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Lumbar Level ◽

Global Sagittal Alignment

Study Design: Retrospective cohort study. Objectives: The current evidence regarding how level of lumbar pedicle subtraction osteotomy (PSO) influences correction of sagittal alignment is limited. This study sought to investigate the relationship of lumbar level and segmental angular change (SAC) of PSO with the magnitude of global sagittal alignment correction. Methods: This study retrospectively evaluated 53 consecutive patients with adult spinal deformity who underwent lumbar PSO at a single institution. Radiographs were evaluated to quantify the effect of PSO on lumbar lordosis (LL), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), T1-spinopelvic inclination (T1SPI), T1-pelvic alignment (TPA), and sagittal vertical axis (SVA). Results: Significant correlations were found between PSO SAC and the postoperative increase in LL ( r = 0.316, P = .021) and PT ( r = 0.352, P = .010), and a decrease in TPA ( r = −0.324, P = .018). PSO level significantly correlated with change in T1SPI ( r = −0.305, P = .026) and SVA ( r = −0.406, P = .002), with more caudal PSO corresponding to a greater correction in sagittal balance. On multivariate analysis, more caudal PSO level independently predicted a greater reduction in T1SPI (β = −3.138, P = .009) and SVA (β = −29.030, P = .001), while larger PSO SAC (β = −0.375, P = .045) and a greater number of fusion levels (β = −1.427, P = .036) predicted a greater reduction in TPA. Conclusion: This study identified a gain of approximately 3 degrees and 3 cm of correction for each level of PSO more caudal to L1. Additionally, a larger PSO SAC predicted greater improvement in TPA. While further investigation of these relationships is warranted, these findings may help guide preoperative PSO level selection.

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Improvement in cervical lordosis and sagittal alignment after vertebral body sliding osteotomy in patients with cervical spondylotic myelopathy and kyphosis

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine2089 ◽

2020 ◽

Vol 33 (3) ◽

pp. 307-315 ◽

Cited By ~ 1

Author(s):

Dong-Ho Lee ◽

Choon Sung Lee ◽

Chang Ju Hwang ◽

Jae Hwan Cho ◽

Jae-Woo Park ◽

...

Keyword(s):

Vertebral Body ◽

Cervical Spondylotic Myelopathy ◽

Sagittal Alignment ◽

Japanese Orthopaedic Association ◽

Vertical Axis ◽

Sacral Slope ◽

Cervical Lordosis ◽

Sagittal Vertical Axis ◽

Segmental Lordosis

OBJECTIVEVertebral body sliding osteotomy (VBSO) is a safe, novel technique for anterior decompression in patients with multilevel cervical spondylotic myelopathy. Another advantage of VBSO may be the restoration of cervical lordosis through multilevel anterior cervical discectomy and fusion (ACDF) above and below the osteotomy level. This study aimed to evaluate the improvement and maintenance of cervical lordosis and sagittal alignment after VBSO.METHODSA total of 65 patients were included; 34 patients had undergone VBSO, and 31 had undergone anterior cervical corpectomy and fusion (ACCF). Preoperative, postoperative, and final follow-up radiographs were used to evaluate the improvements in cervical lordosis and sagittal alignment after VBSO. C0–2 lordosis, C2–7 lordosis, segmental lordosis, C2–7 sagittal vertical axis (SVA), T1 slope, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and Japanese Orthopaedic Association scores were measured. Subgroup analysis was performed between 15 patients with 1-level VBSO and 19 patients with 2-level VBSO. Patients with 1-level VBSO were compared to patients who had undergone 1-level ACCF.RESULTSC0–2 lordosis (41.3° ± 7.1°), C2–7 lordosis (7.1° ± 12.8°), segmental lordosis (3.1° ± 9.2°), and C2–7 SVA (21.5 ± 11.7 mm) showed significant improvements at the final follow-up (39.3° ± 7.2°, 13° ± 9.9°, 15.2° ± 8.5°, and 18.4 ± 7.9 mm, respectively) after VBSO (p = 0.049, p < 0.001, p < 0.001, and p = 0.038, respectively). The postoperative segmental lordosis was significantly larger in 2-level VBSO (18.8° ± 11.6°) than 1-level VBSO (10.3° ± 5.5°, p = 0.014). The final segmental lordosis was larger in the 1-level VBSO (12.5° ± 6.2°) than the 1-level ACCF (7.2° ± 7.6°, p = 0.023). Segmental lordosis increased postoperatively (p < 0.001) and was maintained until the final follow-up (p = 0.062) after VBSO. However, the postoperatively improved segmental lordosis (p < 0.001) decreased at the final follow-up (p = 0.045) after ACCF.CONCLUSIONSNot only C2–7 lordosis and segmental lordosis, but also C0–2 lordosis and C2–7 SVA improved at the final follow-up after VBSO. VBSO improves segmental cervical lordosis markedly through multiple ACDFs above and below the VBSO level, and a preserved vertebral body may provide more structural support.

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Retrospective Study on Effectiveness of Activ L Total Disc Replacement

10.21203/rs.3.rs-65446/v2 ◽

2020 ◽

Author(s):

Wenzhi Sun ◽

Peng Wang ◽

Hailiang Hu ◽

Chao Kong ◽

Yong Hai ◽

...

Keyword(s):

Clinical Outcomes ◽

Sagittal Alignment ◽

Total Disc Replacement ◽

Clinical Results ◽

Disc Replacement ◽

Sacral Slope ◽

Lateral Spine ◽

Lumbar Total Disc Replacement ◽

The Mean

Abstract Background: The effectiveness of lumbar total disc replacement (TDR) with different prostheses for sagittal alignment has been reported previously. However, there are only few reports on Activ L TDR and no specific evidence regarding whether sagittal alignment affects the clinical outcomes.Methods: 87 patients who underwent mono- or bi-segmental lumbar TDR with ActivL were studied. The films of upright anteroposterior and lateral spine in neutral, flexion, and extension positions were obtained before surgery and at 1 month, 1 and 3 years after surgery. The radiographic parameters such as lumbar lordosis (LL), index level lordosis (IL), pelvic incidence (PI), pelvic tilt (PT), segmental lordosis (SL) and sacral slope (SS) were measured based on the lateral upright radiographs. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analogue scale (VAS) pre- and post-operatively.Results: 87 patients with complete radiographic data were available for a 3-year follow-up period. Of these, 66 received a single-level TDR, and 21 received 2-level TDR. At 1 month, the mean LL was similar to the pre-operative data, and then was significantly increased to 45.1° at 3 years. On an average, the IL tended to significantly increase, while the mean SL at L4-5 was increased from 16.5° pre-operatively to 21.0° at 3 years. The mean SL at L1-2, L2-3, L3-4, and L5-S1, PI, PT and the SS showed no obvious difference after 3 years. In contrast, VAS and ODI scores showed significant improvement after surgery.Conclusions: Activ L TDR showed favorable affect on sagittal alignment, enhancing the IL while preserving the LL and SS. However, satisfactory clinical results for over a 3-year follow-up were not affected by sagittal alignment.

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Retrospective study on effectiveness of Activ L total disc replacement

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02116-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Wenzhi Sun ◽

Peng Wang ◽

Hailiang Hu ◽

Chao Kong ◽

Yong Hai ◽

...

Keyword(s):

Clinical Outcomes ◽

Sagittal Alignment ◽

Total Disc Replacement ◽

Clinical Results ◽

Disc Replacement ◽

Favorable Effect ◽

Sacral Slope ◽

Lateral Spine ◽

The Mean

Abstract Background The effectiveness of lumbar total disc replacement (TDR) with different prostheses for sagittal alignment has been reported previously. However, there are only few reports on Activ L TDR and no specific evidence regarding whether sagittal alignment affects the clinical outcomes. Methods Eighty-seven patients who underwent mono- or bi-segmental lumbar TDR with Activ L were studied. The films of the upright anteroposterior and lateral spine in neutral, flexion, and extension positions were obtained before surgery and at 1 month and 1 and 3 years after surgery. The radiographic parameters such as lumbar lordosis (LL), index level lordosis (IL), pelvic incidence (PI), pelvic tilt (PT), segmental lordosis (SL), and sacral slope (SS) were measured based on the lateral upright radiographs. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) pre- and post-operatively. Results Eighty-seven patients with complete radiographic data were available for a 3-year follow-up period. Of these, 66 received a single-level TDR, and 21 received a 2-level TDR. At 1 month, the mean LL was similar to the pre-operative data and then was significantly increased to 45.1° at 3 years. On average, the IL tended to significantly increase, while the mean SL at L–5 was increased from 16.5° pre-operatively to 21.0° at 3 years. The mean SL at L1–2, L2–3, L3–4, and L5–S1; PI; PT; and SS showed no obvious difference after 3 years. In contrast, VAS and ODI scores showed significant improvement after surgery. Conclusions Activ L TDR showed a favorable effect on sagittal alignment, enhancing the IL while preserving the LL and SS. However, satisfactory clinical results for over a 3-year follow-up were not affected by sagittal alignment.

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Lowest Instrumented Vertebra Selection to S1 or Ilium Versus L4 or L5 in Adult Spinal Deformity: Factors for Consideration in 349 Patients With a Mean 46-Month Follow-Up

Global Spine Journal ◽

10.1177/21925682211009178 ◽

2021 ◽

pp. 219256822110091

Author(s):

Yu-Cheng Yao ◽

Han Jo Kim ◽

Mathieu Bannwarth ◽

Justin Smith ◽

Shay Bess ◽

...

Keyword(s):

Spinal Deformity ◽

Sagittal Alignment ◽

Adult Spinal Deformity ◽

Operating Time ◽

Patient Demographics ◽

Lowest Instrumented Vertebra ◽

Related Quality ◽

Health Related

Study Design: Retrospective cohort study. Objective: To compare the outcomes of patients with adult spinal deformity (ASD) following spinal fusion with the lowest instrumented vertebra (LIV) at L4/L5 versus S1/ilium. Methods: A multicenter ASD database was evaluated. Patients were categorized into 2 groups based on LIV levels—groups L (fusion to L4/L5) and S (fusion to S1/ilium). Both groups were propensity matched by age and preoperative radiographic alignments. Patient demographics, operative details, radiographic parameters, revision rates, and health-related quality of life (HRQOL) scores were compared. Results: Overall, 349 patients had complete data, with a mean follow-up of 46 months. Patients in group S (n = 311) were older and had larger sagittal and coronal plane deformities than those in group L (n = 38). After matching, 28 patients were allocated to each group with similar demographic, radiographic, and clinical parameters. Sagittal alignment restoration at postoperative week 6 was significantly better in group S than in group L, but it was similar in both groups at the 2-year follow-up. Fusion to S1/ilium involved a longer operating time, higher PJK rates, and greater PJK angles than that to L4/L5. There were no significant differences in the complication and revision rates between the groups. Both groups showed significant improvements in HRQOL scores. Conclusions: Fusion to S1/ilium had better sagittal alignment restoration at postoperative week 6 and involved higher PJK rates and greater PJK angles than that to L4/L5. The clinical outcomes and rates of revision surgery and complications were similar between the groups.

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Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis

Journal of Neurosurgery Spine ◽

10.3171/2013.4.spine12651 ◽

2013 ◽

Vol 19 (1) ◽

pp. 90-94 ◽

Cited By ~ 18

Author(s):

Hironobu Sakaura ◽

Tomoya Yamashita ◽

Toshitada Miwa ◽

Kenji Ohzono ◽

Tetsuo Ohwada

Keyword(s):

Lumbar Spine ◽

Clinical Outcome ◽

Interbody Fusion ◽

Sagittal Alignment ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Single Level ◽

The Mean

Object A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues. The purpose of this retrospective study was to elucidate clinical and radiological outcomes after 2-level PLIF for 2-level DS with the least bias in determination of operative procedure. Methods Since 2005, all patients surgically treated for lumbar DS at the authors' hospital have been treated using posterior lumbar interbody fusion (PLIF) with pedicle screws, irrespective of severity of slippage, patient age, or bone quality. The authors conducted a retrospective review of 20 consecutive cases involving patients who underwent 2-level PLIF for 2-level DS and had been followed up for 2 years or longer (2-level PLIF group). They also analyzed data from 92 consecutive cases involving patients who underwent single-level PLIF for single-level DS during the same time period and had been followed for at least 2 years (1-level PLIF group). This second group served as a control. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) score. Fusion status and sagittal alignment of the lumbar spine were assessed by comparing serial plain radiographs. Surgery-related complications and the need for additional surgery were evaluated. Results The mean JOA score improved significantly from 12.8 points before surgery to 20.4 points at the latest follow-up in the 2-level PLIF group (mean recovery rate 51.8%), and from 14.2 points preoperatively to 22.5 points at the latest follow-up in the single-level PLIF group (mean recovery rate 55.3%). At the final follow-up, 95.0% of patients in the 2-level PLIF group and 96.7% of those in the 1-level PLIF group had achieved solid spinal fusion, and the mean sagittal alignment of the lumbar spine was more lordotic than before surgery in both groups. Early surgery-related complications, including transient neurological complications, occurred in 6 patients in the 2-level PLIF group (30.0%) and 11 patients in the 1-level PLIF group (12.0%). Symptomatic adjacent-segment disease was found in 4 patients in the 2-level PLIF group (20.0%) and 10 patients in the 1-level PLIF group (10.9%). Conclusions The clinical outcome of 2-level PLIF for 2-level lumbar DS was satisfactory, although surgery-related complications including symptomatic adjacent-segment disease were not negligible.

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Strategies for prevention of rod fracture in adult spinal deformity: cobalt chrome rod, accessory rod technique, and lateral lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2020.8.spine201037 ◽

2021 ◽

pp. 1-10

Author(s):

Ki Young Lee ◽

Jung-Hee Lee ◽

Kyung-Chung Kang ◽

Sang-Kyu Im ◽

Hae Seong Lim ◽

...

Keyword(s):

Spinal Deformity ◽

Interbody Fusion ◽

Sagittal Alignment ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Lumbar Interbody Fusion ◽

Patient Factors ◽

Rod Fracture ◽

Cobalt Chrome

OBJECTIVERestoring the proper sagittal alignment in adult spinal deformity (ASD) can improve radiological and clinical outcomes, but pseudarthrosis including rod fracture (RF) is a common problematic complication. The purpose of this study was to analyze the methods for reducing the incidence of RF in deformity correction of ASD.METHODSThe authors retrospectively selected 178 consecutive patients (mean age 70.8 years) with lumbar degenerative kyphosis (LDK) who underwent deformity correction with a minimum 2-year follow-up. Patients were classified into the non-RF group (n = 131) and the RF group (n = 47). For predicting the crucial factors of RF, patient factors, radiographic parameters, and surgical factors were analyzed.RESULTSThe overall incidence of RF was 26% (47/178 cases), occurring in 42% (42/100 cases) of pedicle subtraction osteotomy (PSO), 7% (5/67 cases) of lateral lumbar interbody fusion (LLIF) with posterior column osteotomy, 18% (23/129 cases) of cobalt chrome rods, 49% (24/49 cases) of titanium alloy rods, 6% (2/36 cases) placed with the accessory rod technique, and 32% (45/142 cases) placed with the 2-rod technique. There were no significant differences in the incidence of RF regarding patient factors between two groups. While both groups showed severe sagittal imbalance before operation, lumbar lordosis (LL) was more kyphotic and pelvic incidence (PI) minus LL (PI-LL) mismatch was greater in the RF group (p < 0.05). Postoperatively, while LL and PI-LL did not show significant differences between the two groups, LL and sagittal vertical axis correction were greater in the RF group (p < 0.05). Nonetheless, at the last follow-up, the two groups did not show significant differences in radiographic parameters except thoracolumbar junctional angles. As for surgical factors, use of the cobalt chrome rod and the accessory rod technique was significantly greater in the non-RF group (p < 0.05). As for the correction method, PSO was associated with more RFs than the other correction methods, including LLIF (p < 0.05). By logistic regression analysis, PSO, preoperative PI-LL mismatch, and the accessory rod technique were crucial factors for RF.CONCLUSIONSGreater preoperative sagittal spinopelvic malalignment including preoperative PI-LL mismatch was the crucial risk factor for RF in LDK patients 65 years or older. For restoring and maintaining sagittal alignment, use of the cobalt chrome rod, accessory rod technique, or LLIF was shown to be effective for reducing RF in ASD surgery.

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Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes

Global Spine Journal ◽

10.1177/2192568220964453 ◽

2020 ◽

pp. 219256822096445

Author(s):

Azmi Hamzaoglu ◽

Mustafa Elsadig ◽

Selhan Karadereler ◽

Ayhan Mutlu ◽

Yunus Emre Akman ◽

...

Keyword(s):

Neurological Deficit ◽

Vertebral Column ◽

Single Stage ◽

Anterior Column ◽

Vertebral Column Resection ◽

Posterior Vertebral Column Resection ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures ◽

The Mean

Study Design: Retrospective study. Objective: The aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures. Methods: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2. Results: The mean age was 49 years (range 22-83 years). The mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. The mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). The mean LKA improved from 34.7° to 4.9° (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients. Conclusion: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures.

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Posterior Ligamentous Reinforcement of the Upper Instrumented Vertebrae +1 Does Not Decrease Proximal Junctional Kyphosis in Adult Spinal Deformity

Global Spine Journal ◽

10.1177/2192568219868472 ◽

2019 ◽

Vol 10 (6) ◽

pp. 692-699

Author(s):

Sravisht Iyer ◽

Francis Lovecchio ◽

Jonathan Charles Elysée ◽

Renaud Lafage ◽

Michael Steinhaus ◽

...

Keyword(s):

Cohort Study ◽

Spinal Deformity ◽

Soft Tissues ◽

Sagittal Alignment ◽

Adult Spinal Deformity ◽

Proximal Junctional Kyphosis ◽

Propensity Matching ◽

Surgical Data ◽

Junctional Kyphosis

Study Design: Retrospective cohort study. Objectives: Violation of the posterior soft tissues is believed to contribute to the development of proximal junctional kyphosis (PJK). Biomechanical and clinical studies suggest that augmentation of the posterior ligamentous structures (PLS) may help prevent PJK. The purpose of this study was to evaluate the effect of PLS augmentation on the rate of PJK at 1 year. Methods: A retrospective single-surgeon cohort study was performed of 108 adult spinal deformity patients who underwent 5 level fusions to the pelvis. Patients were divided into 2 groups: PLS+ patients had reconstruction of the PLS between upper instrumented vertebrae +1 (UIV+1) and UIV−1 with a surgical nylon tape while PLS− patients did not. Demographics, surgical data, and sagittal alignment parameters were compared between the cohorts. The primary outcome of interest was the development of PJK at final follow-up. A subgroup propensity match and logistic regression model were utilized to control for differences in the cohorts. Results: A total of 108 patients met final criteria, 31 patients (28.7%) were PLS+. There were no differences with regard to preoperative or final sagittal alignment parameters, number of levels fused, rates of 3-column osteotomies, and body mass index ( P > .05), though the PLS+ cohort was older and had larger initial sagittal corrections ( P < .05). The rates of PJK for PLS+ (27.3%) and PLS− (28.6%) were similar ( P = .827). After controlling for sagittal correction via propensity matching, PLS+ had no impact on PJK (29% vs 38.7%, P = .367). In our multivariate analysis, only increased sagittal malalignment and failure to restore sagittal balance were retained as significant predictors of PJK. Conclusion: Even after controlling for extent of correction and preoperative sagittal alignment, PLS reinforcement at UIV+1 using a hand-tensioned nylon tape does not reduce the incidence of PJK at 1 year.

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Long-term effects of the Chêneau brace on coronal and sagittal alignment in adolescent idiopathic scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2015.2.spine14970 ◽

2015 ◽

Vol 23 (4) ◽

pp. 505-509 ◽

Cited By ~ 18

Author(s):

Ming-Qiao Fang ◽

Chong Wang ◽

Guang-Heng Xiang ◽

Chao Lou ◽

Nai-Feng Tian ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Sagittal Alignment ◽

Vertical Axis ◽

Sacral Slope ◽

Long Term Effects ◽

Sagittal Vertical Axis ◽

Pelvic Parameters

OBJECT The aim of the present study was to retrospectively evaluate progressive correction of coronal and sagittal alignment and pelvic parameters in patients treated with a Chêneau brace. METHODS Thirty-two patients with adolescent idiopathic scoliosis (AIS) were assessed before initiation of bracing treatment and at the final follow-up. Each patient underwent radiological examinations, and coronal, sagittal, and pelvic parameters were measured. RESULTS No statistically significant modification of the Cobb angle was noted. The pelvic incidence remained unchanged in 59% of the cases and increased in 28% of the cases. The sacral slope decreased in 34% of the cases but remained unchanged in 50%. Thoracic kyphosis and lumbar lordosis were significantly decreased, whereas the sagittal vertical axis was significantly increased from a mean of -44.0 to -30.2 mm (p = 0.02). The mean pelvic tilt increased significantly from 4.5° to 8.3° (p = 0.002). CONCLUSIONS The Chêneau brace can be useful for preventing curvature progression in patients with AIS. However, the results of this study reveal high variability in the effect of brace treatment on sagittal and pelvic alignment. Treatment with the Chêneau brace may also influence sagittal global balance.

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