Spirometry Examination of Adolescents with Thoracic Idiopathic Scoliosis: Is Correction for Height Loss Useful?

Loss of body height is observed in patients with idiopathic scoliosis (IS) due to spine curvatures. The study compared pulmonary parameters obtained from spirometry examination considering the measured versus the corrected body height. One hundred and twenty adolescents with Lenke type 1 or 3 IS who underwent preoperative spirometry examination and radiographic evaluation were enrolled. The mean thoracic Cobb angle was 68° ± 12.6, range 48–102°. The difference between the measured and the corrected body height increased with the greater Cobb angle. Using the corrected body height instead of the measured body height significantly changed the predicted values of pulmonary parameters and influenced the interpretation of the pulmonary testing results.

Sequential correction using satellite rod for severe thoracic idiopathic scoliosis: an effective method to optimize deformity correction

OBJECTIVE The aim of this paper was to compare the radiographic and clinical outcomes between the sequential correction (SC) technique and the traditional 2-rod correction (TC) technique in patients with severe thoracic idiopathic scoliosis (STIS) undergoing posterior-only correction surgery. METHODS Records of a consecutive series of STIS patients undergoing posterior-only correction surgery between October 2013 and October 2017 with more than 2 years of follow-up were reviewed. The radiographic parameters were assessed preoperatively, postoperatively, and at the last follow-up. Radiographic parameters, operative time, blood loss, and complications were compared between the two groups. RESULTS A total of 33 patients were included in the SC group, and 21 patients were included in the TC group. There was no significant difference in age, sex, or deformity magnitude (93.6° ± 7.8° vs 89.8° ± 6.6°, p = 0.070) preoperatively between groups. The operation time was shorter in the SC group than in the TC group (251.5 ± 42.8 minutes vs 275.4 ± 39.8 minutes, p = 0.020), while both blood loss (1284.6 ± 483.3 vs 1398.0 ± 558.4 ml, p = 0.432) and number of fused levels (13.1 ± 2.8 vs 13.6 ± 2.4, p = 0.503) were similar between the groups. Compared with the TC group, patients in the SC group had a higher correction rate (55.8% ± 9.2% vs 45.7% ± 8.8%, p < 0.001), less coronal (1.1° ± 0.81° vs 2.9° ± 0.93°, p < 0.001) and sagittal (1.5° ± 0.96° vs 2.1° ± 0.64°, p = 0.015) correction loss at the 2-year follow-up, and a lower incidence of intraoperative pedicle screw pullout (14.3% vs 23.8%, p = 0.026). CONCLUSIONS The SC technique could significantly and practically reduce the difficulty of rod installation with better deformity correction outcomes than the traditional TC technique. The SC technique was an effective alternative for patients with STIS.

Global sagittal alignment after surgery of right thoracic idiopathic scoliosis in adolescents and adults with and without thoracic hypokyphosis

This study aimed to characterize global sagittal alignment in adolescent idiopathic scoliosis (AIS) with normal kyphosis (NTK, kyphosis > 10°) and with thoracic hypokyphosis (THK, kyphosis < 10°), before and after posterior spinal fusion, and compare them with asymptomatic controls. 27 AIS girls and young adults with right thoracic curves were included (seventeen with age ≤ 18 years, then age > 21). Biplanar radiographies were acquired at baseline, immediate post-operatively, 1-year and 2-year follow-up, and 3D reconstruction of the spine and pelvis was performed. NTK and THK showed different global sagittal alignment, as well as differences compared to controls. AIS with THK at baseline had higher SVA/SFD (2.0 ± 2.9 vs − 0.4 ± 1.9; P < 0.05) and OD-HA (0.2 ± 1.4° vs − 1.3 ± 1.6°; P < 0.05) than controls, indicating that THK had compensated balance with unusual forward leaning posture. Immediately post-operation, SVA/SFD remained high (1.3 ± 3.0) while OD-HA reversed (− 1.2 ± 1.7°), indicating that THK patients had found partially compensated balance. After 2-yeas, both SVA/SFD (− 1.3 ± 2.1) and OD-HA (− 1.4 ± 0.9°) were normalized. The changes in global sagittal alignment and mechanism of balance are different in AIS with or without THK. As the head plays a critical role on balance during immediate and delayed post-operation, OD-HA can be complementary parameter for assessing global balance during post-operative follow-up of AIS patients with THK.