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Campbell RE, Rudic T, Hafey A, Driskill E, Newton PO, Bachmann KR. Impact of preoperative lumbosacral takeoff flexibility on postoperative correction following spinal fusion for adolescent idiopathic scoliosis: a new consideration for selective thoracic fusion. Spine Deform 2025:10.1007/s43390-025-01063-6. [PMID: 40080260 DOI: 10.1007/s43390-025-01063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 02/10/2025] [Indexed: 03/15/2025]
Abstract
PURPOSE Nonselective fusion for adolescent idiopathic scoliosis results in greater correction of the Lumbosacral Takeoff Angle (LSTOA); however, there are patients selectively fused that still have considerable change in their LSTOA. We sought to identify the relationship between preoperative LSTOA flexibility and postoperative correction of the LSTOA. METHODS This was a retrospective analysis of Lenke 1-6, lumbar B and C modifier patients in the Harms Study Group with 2-year follow-up. Only patients with a lumbar Cobb angle ≥ 38 and ≤ 56 were included. The cases were divided into selective (SF: 177) and nonselective fusions (NSF: 324). Multivariate regression analysis was used to identify independent preoperative factors associated with postoperative LSTOA, and postoperative LSTOA correction in the NSF and SF groups. RESULTS The mean postoperative LSTOA correction was 6.1 ± 3.8, with 75 (15%) patients experiencing postoperative worsening of their LSTOA. Among other variables, larger LSTOA (p < 0.001) and smaller bending LSTOA correction (p < 0.001) were predictors of larger postoperative LSTOAs in both groups. Among other variables, larger LSTOA (p < 0.001), and larger bending LSTOA correction (p < 0.01) were predictors of greater LSOTA correction in both groups. Satisfactory LSTOA correction in the selective fusion group was associated with larger preoperative LSTOA (p < 0.001), larger bending LSTOA correction (p < 0.001), larger lumbar Cobb angle bending correction (p: 0.034), and smaller lumbar apex to LIV distance (p: 0.003). CONCLUSIONS Preoperative static and bending LSTOA measurements may help surgeons decide between selective and non-selective fusion in patients with AIS. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Richard E Campbell
- Department of Orthopedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA, 22908, USA
| | - Theodore Rudic
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Alexander Hafey
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth Driskill
- Department of Orthopedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA, 22908, USA
| | - Peter O Newton
- Division of Orthopedics and Scoliosis, Rady Children'S Hospital, San Diego, CA, USA
| | - Keith R Bachmann
- Department of Orthopedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA, 22908, USA.
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Seki S, Newton PO, Makino H, Futakawa H, Kamei K, Yashima Y, Kawaguchi Y. Counter-Rotate Technique Is Substantial for Correcting Thoracolumbar/Lumbar Curvature in AIS Patients with Thoracic Scoliosis. J Clin Med 2025; 14:706. [PMID: 39941378 PMCID: PMC11818868 DOI: 10.3390/jcm14030706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 01/10/2025] [Accepted: 01/18/2025] [Indexed: 02/16/2025] Open
Abstract
Background/Objectives. Correction of thoracolumbar/lumbar curvature in adolescent idiopathic scoliosis (AIS) patients with Lenke 1-2 B and C is still controversial, with regard to extension of the caudal side to the lowest instrumented vertebra (LIV) and method of correction. We assessed the association between change in thoracolumbar/lumbar curvature after surgery with counterrotate technique (CRT) and clinical factors in 45 thoracic AIS patients. Methods. Forty-five AIS patients (mean follow-up 5.1 y, age 15 y, Type B: 28, Type C: 17) were analyzed. Posterior spinal fusion was performed by the placing of segmental uni-planar screws, concave rod rotation, differential rod countering, and segmental CRT. Association between change in thoracolumbar/lumbar curvature after surgery with counter-rotate technique and clinical factors was analyzed in 45 thoracic AIS patients. Results. Mean main thoracic Cobb angle was 52°, and mean thoracolumbar/lumbar curvature Cobb angle was 35°. Postoperative thoracolumbar/lumbar Cobb was 10.1, and final follow-up was 8.2. Multi logistic regression analysis of change in thoracolumbar/lumbar Cobb after surgery was performed. Age (p < 0.05), Risser sign (p < 0.05), and postoperative thoracolumbar/lumbar Cobb (p < 0.0001) were significantly associated with a change in Cobb angle. Conclusions. Correction of thoracolumbar/lumbar curvature using CRT showed significant improvement of thoracolumbar/lumbar curvature, LIV tilting angle, and vertebral rotation. Postoperative thoracolumbar/lumbar Cobb angle (1st erect) was the most significant factor associated with deterioration of thoracolumbar/lumbar curvature after surgery. Subsequent rotational correction of thoracolumbar/lumbar curvature is likely to prevent the deterioration of thoracolumbar/lumbar Cobb after surgery.
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Affiliation(s)
- Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan; (H.M.); (H.F.); (Y.Y.); (Y.K.)
| | - Peter O. Newton
- Department of Orthopedics, Rady Children’s Hospital-San Diego, 3020 Children’s Way, San Diego, CA 92123, USA;
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan; (H.M.); (H.F.); (Y.Y.); (Y.K.)
| | - Hayato Futakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan; (H.M.); (H.F.); (Y.Y.); (Y.K.)
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Toyama Red Cross Hospital, 2-1-58 Ushijima Honmachi, Toyama 930-8562, Japan;
| | - Yushi Yashima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan; (H.M.); (H.F.); (Y.Y.); (Y.K.)
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan; (H.M.); (H.F.); (Y.Y.); (Y.K.)
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Campbell RE, Rudic T, Hafey A, Driskill E, Newton PO, Bachmann KR. Curve progression following selective and nonselective spinal fusion for adolescent idiopathic scoliosis: are selective fusions stable? Spine Deform 2025; 13:177-187. [PMID: 39160427 PMCID: PMC11729213 DOI: 10.1007/s43390-024-00943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/30/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE The purpose of this study is to compare postoperative outcomes between selective and non-selective fusions longitudinally over the first five postoperative years. METHODS Patient parameters were retrieved from a multicenter, prospective, database. Patients with Lenke 1-6, B and C deformities were included. Patients were stratified into 2 groups: selective fusion (SF), if the last instrumented vertebra (LIV) was at or cranial to the lumbar apex, or non-selective fusion (NSF). Differences in coronal and sagittal radiographic outcomes were assessed with generalized linear models (GLMs) at 1-, 2- and 5- year postoperative outcomes. Five-year postoperative categorical radiographic outcomes, flexibility, scoliosis research society scores (SRS), and reoperation rates were compared between groups. Matched cohorts were created for subgroup analysis. RESULTS 416 (SF:261, NF:155) patients, including 353 females were included in this study. The mean preoperative thoracic and lumbar Cobb angles were 57.3 ± 8.9 and 45.3 ± 8.0, respectively. GLMs demonstrated greater postoperative coronal deformity in the SF group (p < 0.01); however, the difference between groups did not change overtime (p > 0.05) indicating a relatively stable postoperative deformity correction. The SF group had a greater incidence of lumbar Cobb ≥ 26 degrees (p < 0.01). The NSF group demonstrated worse forward and lateral flexibility at 5-year postoperative outcome (p < 0.05). There was no difference in postoperative SRS scores between the SF and NSF groups. Reoperation rates were similar between groups. CONCLUSION Selective fusion results in greater coronal plane deformity; however, this deformity does not progress significantly over time compared to non-selective fusion. Selective spinal fusion may be a beneficial option for a larger subset of patients than previously identified. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Richard E Campbell
- Department of Orthopedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA, 22908, USA
| | - Theodore Rudic
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Alexander Hafey
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth Driskill
- Department of Orthopedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA, 22908, USA
| | - Peter O Newton
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA
| | - Keith R Bachmann
- Department of Orthopedic Surgery, University of Virginia Health System, PO Box 800159, Charlottesville, VA, 22908, USA.
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Cai Z, Liu W, Dai Y, Shi B, Zhu Z, Qiu Y. Prediction Model for Lumbar Curve Correction After Selective Thoracic Fusion in Lenke 1 and 2 Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2024; 49:1361-1369. [PMID: 38940221 DOI: 10.1097/brs.0000000000005078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To identify independent risk factors and construct a prediction model for lumbar curve correction (LCC) after selective thoracic fusion (STF) in patients with Lenke 1 and 2 adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA STF has been widely applied to Lenke 1 and 2 AIS patients. However, LCC after STF is still controversial. METHODS One hundred twenty-eight patients undergoing STF with at least 2 years of follow-up were included. Cases were divided into a high-LCC group and a low-LCC group according to a rounded-up median of 65%. Forty-nine variables were taken into account. Logistic regression was applied to identify independent predictive factors. A prediction model was established by backward stepwise regression, and its evaluation was implemented on R. RESULTS Five parameters showed independent predictive value for low LCC: right shoulder higher before surgery (right shoulder higher versus balanced: odds ratio [OR]=0.244, P =0.014), postoperative Cobb angle of lumbar curve (LC) (OR=1.415, P =0.001, cutoff value=11°), lowest instrumented vertebra (LIV) distal to end vertebra (no vs. yes: OR=4.587, P =0.013), postoperative LIV tilt (OR=0.686, P =0.010, cutoff value=6.85°) and postoperative LIV+1 tilt (OR=1.522, P =0.005, cutoff value=6.25°). The prediction model included 6 variables: lumbar modifier, preoperative shoulder balance, postoperative Cobb angle of LC, LIV position, postoperative LIV tilt, and postoperative LIV+1 tilt. The model evaluation demonstrated satisfactory capability and stability (area under curve=0.890, 10-fold cross-validation accuracy=0.782). CONCLUSION Preoperative shoulder balance, Cobb angle of LC, LIV position, postoperative LIV and LIV+1 tilt could be used to prognosticate LCC after STF. A model with solid prediction ability was established, which could further our understanding of LCC and assist in making clinical decisions.
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Affiliation(s)
- Zhenning Cai
- Division of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, P. R. China
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Banno T, Yamato Y, Hasegawa T, Yoshida G, Arima H, Oe S, Ide K, Yamada T, Kurosu K, Matsuyama Y. Evaluation of the changes in waistline asymmetry using digital photography in adolescents with idiopathic thoracolumbar/lumbar scoliosis after corrective surgery. Spine Deform 2024; 12:1079-1088. [PMID: 38526692 DOI: 10.1007/s43390-024-00850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/18/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Waist line asymmetry is a major cosmetic concern in patients with adolescent idiopathic scoliosis (AIS). The primary surgical goal in patients with AIS is to correct spinal deformities and prevent further progression while maintaining global alignment. Additionally, an important objective of surgical treatment is to address physical appearance by reducing asymmetry. This study aimed to evaluate changes in waistline asymmetry using digital photographs in adolescents with thoracolumbar/lumbar (TL/L) scoliosis who underwent corrective surgery. METHODS We retrospectively analyzed the data of patients with Lenke types 5C and 6C AIS who underwent posterior fusion surgery with at least 2 years of follow-up. Waist line asymmetry was assessed using digital photography. The waist angle ratio (WAR), waist height angle (WHA), and waistline depth ratio (WLDR) were measured pre- and postoperatively. Radiographic parameters and the revised 22-item Scoliosis Research Society Questionnaire (SRS-22r) were also evaluated. RESULTS Forty-two patients (40 females and 2 males; 34 with type 5C and 8 with type 6C) were included in the study. The WAR, WHA, and WLDR significantly improved after surgery (0.873 → 0.977, - 2.0° → 1.4°, and 0.321 → 0.899, respectively). Every waistline parameter moderately correlated with the apical vertebral translation of the TL/L curve (WAR: r = - 0.398, WHA: r = - 0.442, and WLDR: r = - 0.692), whereas no correlations were observed with the TL/L curve magnitude. No correlations were observed between the photographic parameters and SRS-22r scores. CONCLUSION Lateral displacement of the apical vertebra on the TL/L curve correlated with waistline asymmetry. Preoperative waistline asymmetry improved with scoliosis correction. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan.
- Division of Surgical Care, Morimachi, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan.
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kenta Kurosu
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Zhang Y, Bai J, Xiao B, Zhang J, He D, Xing Y, Liu B. Satisfactory immediate spontaneous correction may not mean satisfactory final results for moderate TL/L curves after selective thoracic fusion in AIS patients. BMC Musculoskelet Disord 2023; 24:543. [PMID: 37393267 PMCID: PMC10314374 DOI: 10.1186/s12891-023-06591-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/01/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Few studies have focused on the chronic spontaneous behavior of the unfused TL/L curve during follow-up. The purpose of the present study was to explore the behavior of the unfused TL/L curve during a long-term follow-up to identify the risk factors for correction loss. METHODS Sixty-four age-matched female AIS patients undergoing selective thoracic fusion were enrolled. Patients were divided into 2 groups according to whether there was correction loss. Risk factors for correction loss of the unfused TL/L curves were analyzed. The relationship and difference between the immediate postoperative thoracic and TL/L Cobb angles were explored. RESULTS The TL/L Cobb angle was 28.17° before surgery, 8.60° after surgery, and 10.74° at the final follow-up, with a correction loss of 2.14°. Each subgroup contained 32 cases. A smaller postoperative TL/L Cobb angle was the only risk factor that was independently associated with TL/L correction loss. In the LOSS group, there was a significant difference and no correlation between the immediate postoperative TL/L and the thoracic Cobb angle. In the NO-LOSS group, there was a moderate correlation and no difference between them. CONCLUSION A smaller immediate postoperative TL/L Cobb angle may have been associated with TL/L correction loss during the long-term follow-up. Thus, good immediate postoperative spontaneous correction may not mean a satisfactory outcome at the final follow-up after STF. Mismatch between thoracic and TL/L Cobb angles immediately after surgery may also be related to correction loss of the unfused TL/L curves. Close attention should be paid in case of deterioration.
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Affiliation(s)
- Yanbin Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Xicheng District Xinjiekou No. 31 East Street, Beijing, 100035 P.R. China
| | - Jing Bai
- Department of Trauma and Joint, The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine, Chaoyang District Anwai Xiaoguan Street No. 51, Beijing, 100029 P.R. China
| | - Bin Xiao
- Department of Spine Surgery, Beijing Jishuitan Hospital, Xicheng District Xinjiekou No. 31 East Street, Beijing, 100035 P.R. China
| | - Jianguo Zhang
- Department of Orthopedics of Peking Union Medical College Hospital, 1Shuai Fu Yuan, Beijing, 100730 P.R. China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Xicheng District Xinjiekou No. 31 East Street, Beijing, 100035 P.R. China
| | - Yonggang Xing
- Department of Spine Surgery, Beijing Jishuitan Hospital, Xicheng District Xinjiekou No. 31 East Street, Beijing, 100035 P.R. China
| | - Bo Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Xicheng District Xinjiekou No. 31 East Street, Beijing, 100035 P.R. China
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Banno T, Yamato Y, Oba H, Ohba T, Hasegawa T, Yoshida G, Arima H, Oe S, Ide K, Yamada T, Takahashi J, Haro H, Matsuyama Y. Clinical differences in preoperative symptoms and surgical outcomes between early and late-teen patients with Lenke type 5C adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2541-2549. [PMID: 37209208 DOI: 10.1007/s00586-023-07758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/14/2023] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE This study aimed to compare the clinical features and postoperative outcomes in patients with Lenke type 5C AIS in the early and late teens. METHODS The study included eligible patients with AIS aged < 20 years with Lenke type 5C curves who underwent selective thoracolumbar/lumbar (TL/L) fusion. The patients were divided into two groups according to the age: younger (11-15 years) and older (16-19 years). Demographic data, radiographic parameters, and 22-item scoliosis research society questionnaire (revised) (SRS-22r) scores were compared. RESULTS Seventy-three (female: 69, male: 4, mean age: 15.1 years) patients were included. There were 45 and 28 patients in the younger and older groups, respectively. The older group exhibited a significantly smaller TL/L curve than the younger group, whereas no between-group differences were identified regarding curve flexibility and fusion length. The change in coronal balance and subjacent disc angle from preoperative to 2 years after surgery was significantly greater in the younger group, although each curve was equally corrected. Preoperative SRS-22r scores in the older group were significantly worse; however, they improved to the level of the younger group at 2 years after surgery. Postoperative coronal malalignment was observed in six patients (21.4%) in the older group, whereas no cases in the younger group (p < 0.05). CONCLUSION In patients with Lenke type 5C AIS, we showed that late teens had significantly worse SRS-22r scores than did early teens. Postoperative coronal malalignment was frequently observed in the late teens due to the reduced ability of compensation by subjacent disc wedging.
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Affiliation(s)
- Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Hiroki Oba
- Department of Orthopedic Surgery, Shinshu University, Matsumoto, Nagano, Japan
| | - Tetsuro Ohba
- Department of Orthopedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University, Matsumoto, Nagano, Japan
| | - Hirotaka Haro
- Department of Orthopedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Banno T, Yamato Y, Oba H, Ohba T, Hasegawa T, Yoshida G, Arima H, Oe S, Ide K, Yamada T, Takahashi J, Haro H, Matsuyama Y. Risk factors and clinical impact of persistent coronal imbalance after posterior spinal fusion in thoracolumbar/lumbar idiopathic scoliosis. J Neurosurg Spine 2022; 37:883-892. [PMID: 35901689 DOI: 10.3171/2022.5.spine22385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Persistent coronal imbalance (PCI) can develop postoperatively. In this study, the authors aimed to clarify the risk factors and clinical impact of PCI after posterior spinal fusion (PSF) in idiopathic scoliosis (IS) patients with a major thoracolumbar/lumbar (TL/L) curve. METHODS Data on 108 patients with Lenke type 5C or 6C IS who underwent PSF with a minimum of 2 years of follow-up were retrospectively analyzed. PCI was defined as coronal imbalance persisting 2 years after surgery. Radiographic parameters and clinical outcomes were compared between the PCI (+) and PCI (-) groups. Multivariate regression analyses of associated factors were performed to determine the risk factors for PCI. RESULTS Of the 108 patients, 48 (44%) had immediate postoperative coronal imbalance, and 10 of these patients (9%) had coronal imbalance persisting 2 years after surgery. The PCI (+) group had significantly worse postoperative subtotal and satisfaction scores than the PCI (-) group. Preoperative apical vertebral translation (AVT) of the TL/L curve (AVT-TL/L) and postoperative coronal balance (CB) were identified as independent risk factors for PCI. The cutoff values of preoperative AVT-TL/L at 49.5 mm (area under the curve [AUC] 0.835, p = 0.001, 95% CI 0.728-0.941, sensitivity 70.0%, specificity 72.4%) and those of postoperative CB at -27.5 mm (AUC 0.837, p < 0.001, 95% CI 0.729-0.945, sensitivity 78.6%, specificity 70.0%) were used to predict PCI. In selective fusion cases, older age (OR 2.110, 95% CI 1.159-3.842, p = 0.015), greater preoperative AVT-TL/L (OR 1.199, 95% CI 1.029-1.398, p = 0.020), and less postoperative CB (OR 0.855, 95% CI 0.743-0.983, p = 0.027) were independent risk factors for PCI. CONCLUSIONS Preoperative AVT-TL/L and postoperative CB are important parameters for predicting PCI. PCI adversely affects postoperative clinical outcomes. In selective fusion surgery, PCI tends to occur in older patients due to reduced flexibility and compensatory abilities.
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Affiliation(s)
- Tomohiro Banno
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Yu Yamato
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hiroki Oba
- 2Department of Orthopaedic Surgery, Shinshu University, Matsumoto, Nagano
| | - Tetsuro Ohba
- 3Department of Orthopaedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Tomohiko Hasegawa
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Go Yoshida
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hideyuki Arima
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Shin Oe
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Koichiro Ide
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Tomohiro Yamada
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Jun Takahashi
- 2Department of Orthopaedic Surgery, Shinshu University, Matsumoto, Nagano
| | - Hirotaka Haro
- 3Department of Orthopaedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Yukihiro Matsuyama
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
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Simultaneous Hypercorrection of Lowest Instrumented Vertebral Tilt and Main Thoracic Curve is Associated With Progression of Residual Lumbar Curve in Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2022; 47:1362-1371. [PMID: 35867582 DOI: 10.1097/brs.0000000000004403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To determine radiographic parameters, including the lowest instrumented vertebral (LIV) tilt, related to the postoperative magnitude and progression of residual lumbar curves (LCs) in adolescent idiopathic scoliosis patients who underwent posterior spinal fusion with LIV at or above L1. SUMMARY OF BACKGROUND DATA Although several guidelines have been proposed for thoracic curve fusion, factors related to the postoperative magnitude and potential progression of unfused LCs remained undetermined. The effect of the LIV tilt on residual LCs is also unclear. MATERIALS AND METHODS Patients with Lenke type 1 to 4 curves who underwent posterior spinal fusion with LIV at or above L1 with a minimum follow-up period of 2 years were evaluated. Prediction models for residual LCs were developed using multivariate linear regressions with selected radiographic parameters. Subgroup analyses, followed by sensitivity tests, were then performed for variables best predicting the progression of residual LCs. RESULTS A total of 130 patients were included. Multivariate linear regression analysis showed that the immediate postoperative LIV-tilt angle was associated with the immediate postoperative LCs and the prediction model for residual LCs, with high accuracy ( R =0.93 and 0.77, respectively). Sensitivity tests revealed immediate postoperative LIV-tilt angle <10° and correction rate of main thoracic curve Cobb angle >53% as predictors for progression of residual LCs, and they reached moderate discrimination when combined together as one criterion (odds ratio=16.3, 95% confidence interval=5.3-50.1; sensitivity=89%, specificity=67%, positive predicted value=51%, negative predicted value=94%). CONCLUSION The current study revealed that LIV tilt, as an operable factor during surgery, is not only a determinant in prediction models showing high correlation with the magnitude of postoperative LCs but a predictor for progression of residual LCs. "Immediate postoperative LIV-tilt angle <10° and correction rate of main thoracic curve Cobb angle >53%," as a united criterion, could serve as a predictor for progression of residual LCs.
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Banno T, Yamato Y, Oba H, Ohba T, Hasegawa T, Yoshida G, Arima H, Oe S, Mihara Y, Ide K, Takahashi J, Haro H, Matsuyama Y. Should the upper end vertebra be selected as the upper instrumented vertebra in patients with Lenke type 5C adolescent idiopathic scoliosis? Spine Deform 2022; 10:1139-1148. [PMID: 35322389 DOI: 10.1007/s43390-022-00496-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Retrospective study. PURPOSE The upper end vertebra (UEV) is often selected as the upper instrumented vertebra (UIV) in patients with adolescent idiopathic scoliosis (AIS) with Lenke type 5C curves; however, the effect of adjusting UIV selection one level toward the cranial side (UEV + 1) is unknown. Therefore, this study aimed to assess the effect of UIV extension on scoliosis correction and global alignment in patients with the UIV as the UEV and UEV + 1. METHODS Data of 52 patients with AIS with Lenke type 5C curves who underwent selective thoracolumbar/lumbar (TL/L) fusion with a minimum follow-up period of 2 years were retrospectively analyzed. The patients were divided according to the UIV in relation to the UEV: the UEV and UEV + 1 groups. Radiographic parameters and clinical outcomes were compared between the two groups. RESULTS Among the 52 patients, 24 and 28 were included in the UEV and UEV + 1 group. Baseline data showed no intergroup differences except for the UIV level. While the UEV + 1 group showed a significantly greater TL/L curve correction (72.9% vs. 62.8%, p < 0.05) and a lower UIV tilt, it showed a significantly greater absolute value of radiographic shoulder height (RSH) (- 7.9 vs. - 0.9 mm, p < 0.05) and coronal balance (- 11.0 mm vs - 4.8 mm, p < 0.05) at 2 years postoperatively. The rate of post-operative shoulder imbalance (RSH ≥ 2 cm) was significantly higher in the UEV + 1 than in the UEV group. No intergroup differences were observed in the sagittal alignment and patient outcomes between the two groups. CONCLUSION When the UIV was selected as the UEV + 1, correction of the TL/L curve improved; however, it increased the risk of shoulder and coronal imbalance. There is no clinical benefit observed in terms of extending the UIV to the UEV + 1; therefore, the UIV should be selected as the UEV to maintain harmonious global alignment. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hiroki Oba
- Department of Orthopedic Surgery, Shinshu University, Matsumoto, Nagano, Japan
| | - Tetsuro Ohba
- Department of Orthopedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yuki Mihara
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University, Matsumoto, Nagano, Japan
| | - Hirotaka Haro
- Department of Orthopedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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Banno T, Yamato Y, Oba H, Ohba T, Hasegawa T, Yoshida G, Arima H, Oe S, Mihara Y, Ushirozako H, Takahashi J, Haro H, Matsuyama Y. Preoperative pelvic obliquity: possible relation to postoperative coronal decompensation in thoracolumbar/lumbar adolescent idiopathic scoliosis. J Neurosurg Spine 2022; 36:193-202. [PMID: 34560635 DOI: 10.3171/2021.4.spine21265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/19/2021] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Tomohiro Banno
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Yu Yamato
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hiroki Oba
- 2Department of Orthopedic Surgery, Shinshu University, Matsumoto, Nagano; and
| | - Tetsuro Ohba
- 3Department of Orthopedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Tomohiko Hasegawa
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Go Yoshida
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hideyuki Arima
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Shin Oe
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Yuki Mihara
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hiroki Ushirozako
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Jun Takahashi
- 2Department of Orthopedic Surgery, Shinshu University, Matsumoto, Nagano; and
| | - Hirotaka Haro
- 3Department of Orthopedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Yukihiro Matsuyama
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
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12
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Banno T, Yamato Y, Oba H, Ohba T, Hasegawa T, Yoshida G, Arima H, Oe S, Mihara Y, Ushirozako H, Takahashi J, Haro H, Matsuyama Y. Should L3 be selected as the lowest instrumented vertebra in patients with Lenke type 5C adolescent idiopathic scoliosis whose lowest end vertebra is L4? J Neurosurg Spine 2021; 35:330-339. [PMID: 34243158 DOI: 10.3171/2020.11.spine201807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE L3 is most often selected as the lowest instrumented vertebra (LIV) to conserve mobile segments in fusion surgery; however, in cases with the lowest end vertebra (LEV) at L4, LIV selection as L3 could have a potential risk of correction loss and coronal decompensation. This study aimed to compare the clinical and radiographic outcomes depending on the LEV in adolescent idiopathic scoliosis (AIS) patients with Lenke type 5C curves. METHODS Data from 49 AIS patients with Lenke type 5C curves who underwent selective thoracolumbar/lumbar (TL/L) fusion to L3 as the LIV were retrospectively analyzed. The patients were classified according to their LEVs into L3 and L4 groups. In the L4 group, subanalysis was performed according to the upper instrumented vertebra (UIV) level toward the upper end vertebra (UEV and 1 level above the UEV [UEV+1] subgroups). Radiographic parameters and clinical outcomes were compared between these groups. RESULTS Among 49 patients, 32 and 17 were in the L3 and L4 groups, respectively. The L4 group showed a lower TL/L curve correction rate and a higher subjacent disc angle postoperatively than the L3 group. Although no intergroup difference was observed in coronal balance (CB), the L4 group showed a significantly higher main thoracic (MT) and TL/L curve progression during the postoperative follow-up period than the L3 group. In the L4 group, the UEV+1 subgroup showed a higher absolute value of CB at 2 years than the UEV subgroup. CONCLUSIONS In Lenke type 5C AIS patients with posterior selective TL/L fusion to L3 as the LIV, patients with their LEVs at L4 showed postoperative MT and TL/L curve progression; however, no significant differences were observed in global alignment and clinical outcome.
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Affiliation(s)
- Tomohiro Banno
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Yu Yamato
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hiroki Oba
- 2Department of Orthopaedic Surgery, Shinshu University, Matsumoto, Nagano; and
| | - Tetsuro Ohba
- 3Department of Orthopaedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Tomohiko Hasegawa
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Go Yoshida
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hideyuki Arima
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Shin Oe
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Yuki Mihara
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hiroki Ushirozako
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Jun Takahashi
- 2Department of Orthopaedic Surgery, Shinshu University, Matsumoto, Nagano; and
| | - Hirotaka Haro
- 3Department of Orthopaedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Yukihiro Matsuyama
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
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Banno T, Yamato Y, Oba H, Ohba T, Hasegawa T, Yoshida G, Arima H, Oe S, Mihara Y, Ushirozako H, Takahashi J, Haro H, Matsuyama Y. Preoperative Thoracic Curve Magnitude and L4 End Vertebra Were Risk Factors for Subjacent Disc Wedging After Selective Thoracolumbar/Lumbar Fusion with L3 as the Lowest Instrumented Vertebra in Lenke Type 5 Curve Patients. Spine (Phila Pa 1976) 2021; 46:E878-E887. [PMID: 33496533 DOI: 10.1097/brs.0000000000003961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVE This study aimed to investigate the incidence and risk factors of subjacent disc wedging (SDW) in adolescent idiopathic scoliosis (AIS) patients with Lenke type 5 curve. SUMMARY OF BACKGROUND DATA SDW is frequently observed after surgery; however, data about its mechanism and relations with outcome are limited. METHODS Data of 59 patients with AIS with Lenke type 5 curves who underwent posterior spinal fusion to L3 as the lowest instrumented vertebra (LIV) were retrospectively analyzed. The subjacent disc angle (SDA) was defined as the angle between L3 (LIV) and L4. SDW was defined as the absolute value of SDA of 10° or higher 2 years postoperatively. The incidence of SDW was investigated between nonselective and selective thoracolumbar/lumbar (TL/L) fusion group. In the selective group, patients with and without SDW were compared. RESULTS Among 59 patients, 11 had nonselective and 48 had selective fusion. No patients in the nonselective group showed SDW versus 13 patients in the selective group (27%) showed SDW. In the selective group, patients with SDW showed significantly greater main thoracic curve, apical vertebral translation of the main thoracic curve, upper instrumented vertebra tilt, LIV tilt, and SDA 2 years postoperatively, whereas no differences were found in the coronal balance or clinical outcome. Multivariate analysis revealed preoperative T curve and SDA as predictors of SDW occurrence. T curve greater than 30° and SDA greater than 0° were calculated as cutoff values based on the receiver operating characteristic curve. CONCLUSION SDW is sometimes seen in Lenke type 5 patients with AIS who underwent selective TL/L fusion. SDW seemed to occur as a compensation mechanism for progressing deformity of unfused segments (thoracic curve and residual lumbar curve) to maintain coronal alignment. Preoperative T curve > 30° and SDA > 0° (lower-end vertebra as L4) were determined as risk factors for SDW occurrence.Level of Evidence: 3.
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Affiliation(s)
- Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiroki Oba
- Department of Orthopedic Surgery, Shinshu University, Matsumoto, Nagano, Japan
| | - Tetsuro Ohba
- Department of Orthopedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuki Mihara
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiroki Ushirozako
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Jun Takahashi
- Department of Orthopedic Surgery, Shinshu University, Matsumoto, Nagano, Japan
| | - Hirotaka Haro
- Department of Orthopedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Indications for Lumbar Fusion in the Skeletally Mature Adolescent: How to Address Oblique Takeoff and Limb Length Discrepancy. J Pediatr Orthop 2021; 41:S59-S63. [PMID: 34096539 DOI: 10.1097/bpo.0000000000001805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Indications for posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI) of a scoliotic deformity in a skeletally mature individual are based on the balance between the anticipated benefit of stopping future curve progression and the potential downside of loss of spinal mobility. The dilemma regarding PSF with SSI in the adolescent population is exacerbated by the patient's participation in athletics requiring flexibility and motion of the spine, the location of the curve, the presence of pelvic obliquity, and the impact of a limb length discrepancy. The purpose of this review is to discuss the potential advantages and disadvantages of PSF with SSI in a hypothetical skeletally mature adolescent with a 45-degree lumbar curve, pelvic obliquity, and limb length discrepancy. DISCUSSION Natural history studies of untreated adolescent idiopathic scoliosis (AIS) have shown that slow curve progression throughout adulthood is likely. Adults with untreated AIS may also have more back pain and dissatisfaction with their appearance. Although the clinical and radiographic outcomes of PSF with SSI are excellent, patients should be counseled about the impact of fusing the lumbar spine on back pain, decreased spinal mobility, and potential inability to return to athletics at the same level. Adults who undergo surgery for AIS have greater operative morbidity and number of levels fused compared with adolescents. CONCLUSION These factors should be presented when discussing observation versus PSF with SSI with patients and families. Delaying surgery until formal athletic participation is complete should be considered.
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Bachmann KR, Lu E, Novicoff WM, Newton PO, Abel MF. The Lumbosacral Takeoff Angle Can Be Used to Predict the Postoperative Lumbar Cobb Angle Following Selective Thoracic Fusion in Patients with Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am 2020; 102:143-150. [PMID: 31644521 DOI: 10.2106/jbjs.19.00287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Selective fusion of double curves in patients with scoliosis is considered to spare fusion levels. In 2011, we studied the lumbosacral takeoff angle, defined as the angle between the center-sacral vertical line and a line through the centra of S1, L5, and L4. The lumbosacral takeoff angle was shown to moderately correlate with the lumbar Cobb angle, and a predictive equation was developed to predict the lumbar Cobb angle after selective fusions. The purposes of the present study were to validate that equation in a separate cohort and to assess differences in outcomes following selective and nonselective fusion. METHODS Patients with Lenke 1B, 1C, 3B, or 3C curve patterns undergoing fusion (both selective and nonselective) with pedicle screw constructs and a minimum of 2 years of follow-up were included. Selective fusion was defined as a lowest level of fixation cephalad to or at the apex of the lumbar curve. To validate the previously derived equation, we used this data set and analysis of variance to check for differences between the actual and calculated postoperative lumbar Cobb angles. Pearson correlation, multiple linear regression, and t tests were used to explore relationships and differences between the selective and nonselective fusion groups. RESULTS The mean calculated postoperative lumbar Cobb angle (and standard deviation) (22.35° ± 3.82°) was not significantly different from the actual postoperative lumbar Cobb angle (21.08° ± 7.75°), with an average model error of -1.268° (95% confidence interval, -2.649° to 0.112°). The preoperative lumbar Cobb angle was larger in patients with deformities that were chosen for nonselective fusion (50.2° versus 38.9°; p < 0.001). Performing selective fusion resulted in a 3.5° correction of the lumbosacral takeoff angle (p < 0.001), whereas nonselective fusion resulted in a 9.3° correction (p < 0.001). CONCLUSIONS The lumbosacral takeoff angle can be used to predict the residual lumbar Cobb angle and may be used by surgeons to aid in the decision between selective and nonselective fusion. The change in the lumbosacral takeoff angle following selective fusion is small. Improvement in the lumbosacral takeoff angle and coronal balance is greater in association with nonselective fusion. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Keith R Bachmann
- Departments of Orthopaedic Surgery (K.R.B., E.L., W.M.N., and M.F.A.) and Public Health Sciences (W.M.N.), University of Virginia, Charlottesville, Virginia
| | - Edwin Lu
- Departments of Orthopaedic Surgery (K.R.B., E.L., W.M.N., and M.F.A.) and Public Health Sciences (W.M.N.), University of Virginia, Charlottesville, Virginia
| | - Wendy M Novicoff
- Departments of Orthopaedic Surgery (K.R.B., E.L., W.M.N., and M.F.A.) and Public Health Sciences (W.M.N.), University of Virginia, Charlottesville, Virginia
| | - Peter O Newton
- Department of Orthopedics, Rady Children's Hospital, San Diego, California
| | - Mark F Abel
- Departments of Orthopaedic Surgery (K.R.B., E.L., W.M.N., and M.F.A.) and Public Health Sciences (W.M.N.), University of Virginia, Charlottesville, Virginia
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Koller H, Hitzl W, Marks MC, Newton PO. Accurate prediction of spontaneous lumbar curve correction following posterior selective thoracic fusion in adolescent idiopathic scoliosis using logistic regression models and clinical rationale. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1987-1997. [PMID: 31236658 DOI: 10.1007/s00586-019-06000-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 04/17/2019] [Accepted: 05/05/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Accurate prediction of spontaneous lumbar curve correction (SLCC) after selective thoracic fusion (STF) remains difficult. This study sought to improve prediction accuracy of SLCC. The hypothesis was preoperative and intraoperative variables could predict SLCC < 20°. METHODS A multicenter observational prospective analysis was conducted to determine predictors of SLCC in AIS patients that had posterior STF. Curve types included major thoracic curves (Lenke 1, 3-4).The primary outcome variable was to establish prediction models, and a postoperative lumbar curve (LC) ≤ 20° was defined as the target variable. Multivariate logistic regression models were established to study the relationship between selected variables and a LC ≤ 20° versus a LC > 20° at ≥ 2-year follow-up. Single and dual thresholds models in perspective of clinical rationales were applied to find models with the highest positive/negative predictive values (PPV/NPV). The secondary outcome measure was SRS scores at ≥ 2-year follow-up. RESULTS 410 patients were included. At ≥ 2-year follow-up 282 patients had LC ≤ 20°. These patients had better SRS-22 scores than those with LC > 20° (P = 0.02). The postoperative LC and LC ≤ 20° were predicted by preoperative LC and LC-bending Cobb angle (P < 0.01, r = 0.4-0.6). Logistic regression models could be established to identify patients at risk for failing the target LC ≤ 20°.For preoperative LC and LC-bending, the prediction model achieved a NPV/PPV of 80%/72%. If the postoperative main thoracic curve is combined with the preoperative LC and a gray area for difficult decisions was allowed, model accuracy could even be improved (NPV/PPV = 96%/81%). CONCLUSION An accurate prediction model for postoperative SLCC was established based on a large analysis of prospective STF cases. These models can support prediction and understanding of postoperative SLCC aiding in surgical decision making when contemplating a selective thoracic fusion. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- H Koller
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,Department for Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria.
| | - W Hitzl
- Research Office, Biostatistics, Paracelsus Medical University, Salzburg, Austria
| | - M C Marks
- Setting Scoliosis Straight, Harms Study Group, San Diego, USA
| | - P O Newton
- Department of Orthopedic Surgery, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA, USA
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Ishikawa M, Nishiyama M, Kamata M. Selective Thoracic Fusion for King-Moe Type II/Lenke 1C Curve in Adolescent Idiopathic Scoliosis: A Comprehensive Review of Major Concerns. Spine Surg Relat Res 2019; 3:113-125. [PMID: 31435563 PMCID: PMC6690091 DOI: 10.22603/ssrr.2018-0047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/25/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Controversies still exist in the surgical indications and outcomes of selective thoracic fusion (STF) for a primary thoracic curve with a compensatory large lumbar curve (King-Moe type II/Lenke 1C curve) in adolescent idiopathic scoliosis (AIS). Issues of the greatest concern regarding this curve type include curve criteria that indicate STF to prevent postoperative coronal decompensation and postoperative radiographic outcomes, including curve correction, coronal balance, and thoracolumbar kyphosis, after STF. METHODS This review comprehensively documents the issues raised in the literature regarding surgical indications and radiographic outcomes of STF for King-Moe type II/Lenke 1C curve in AIS. RESULTS Studies suggest that radiographic curve criteria indicating STF for this curve type include the preoperative dominance of the thoracic curve to the lumbar curve in the Cobb angle and the characteristics of the lumbar curve in magnitude and flexibility. Studies warn the need for a careful clinical evaluation of the thoracic and lumbar rotational prominences. Documented radiographic outcomes of importance include the postoperative behavior of the unfused lumbar curve, coronal or sagittal decompensation after STF, and factors associated with these issues. A comprehensive review of the literature suggests that the use of a segmental pedicle screw construct and better instrumented thoracic curve correction achieve better spontaneous lumbar curve correction. Although the causes of postoperative coronal decompensation remain multifactorial, preoperative coronal decompensation to the left and an inappropriate selection of the lowest instrumented vertebra are consistently reported to be the major causative factors. CONCLUSIONS STF has been validated in general for the treatment of King-Moe type II or Lenke 1C curve in AIS; however, controversies remain regarding the surgical indications and outcomes. Long-term impacts of residual lumbar curve, coronal decompensation, and mild thoracolumbar kyphosis on clinical outcomes after STF, along with optimal indications and strategy for STF, should further be assessed.
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Affiliation(s)
| | - Makoto Nishiyama
- Spine and Spinal Cord Center, Mita Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Michihiro Kamata
- Department of Orthopaedic Surgery, Keiyu Hospital, Kanagawa, Japan
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Additional Risk Factors for Adding-On After Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis: Implication of Lowest Instrumented Vertebra Angle and Lumbosacral Takeoff. Spine Deform 2018; 6:164-169. [PMID: 29413739 DOI: 10.1016/j.jspd.2017.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/07/2017] [Accepted: 08/10/2017] [Indexed: 11/23/2022]
Abstract
STUDY DESIGN Retrospective chart and radiographic review. OBJECTIVE The purpose of this study was to identify any additional risk factors adding-on after selective thoracic fusion in adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Previous studies have shown that the proper selection of lowest instrumented vertebra (LIV) is critical in preventing adding-on (AD) phenomenon after selective thoracic fusion (STF). However, even after selecting the correct LIV, AD can still occur. METHODS This is a retrospective review of 380 consecutive AIS patients who underwent corrective surgery by a single surgeon. LIV was chosen as stable vertebra (SV) or SV-1 if intersected by the center sacral vertical line (CSVL). One hundred thirty-five patients were identified who had complete radiographic images stored in PACS. After Lenke 5, anterior or combined surgeries, TL fusion, and hybrid construct were excluded, two groups were identified out of 78 patients who received STF with all pedicle screw construct: Adding-on (AD) and Control. AD was defined as >5° angle of the superior endplate of LIV-1 to the inferior endplate of LIV+1 between postoperation and the final follow-up. We analyzed the values for the AD group and compared them with those for the control group to identify risk factors not previously defined. RESULTS Patients with other complication and follow-up less than 2 years were excluded, and there remained 11 patients in AD (14%), and 8 in the control group. There was no significant difference between the 2 groups in terms of demographic data, LIV selection, and curve types. In AD, there was significant curve progression within fused segments. Even though lumbosacral takeoff (LSTO) was not significantly different, (LIV-H)+LSTO and LIV-H (LIV horizontal) showed significant difference. CONCLUSION After excluding the effect of known risk factors for AD, LIV-H angle, and LIV-H mismatch with LSTO were found to be the additional risk factors for AD. In addition to consideration of other risk factors such as LIV selection or Risser stage, these risk factors should be considered.
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Lin Y, Chen W, Chen A, Li F, Xiong W. Anterior versus Posterior Selective Fusion in Treating Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis of Radiologic Parameters. World Neurosurg 2018; 111:e830-e844. [DOI: 10.1016/j.wneu.2017.12.161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/24/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
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Coronal balance in idiopathic scoliosis: a radiological study after posterior fusion of thoracolumbar/lumbar curves (Lenke 5 or 6). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1775-1781. [DOI: 10.1007/s00586-016-4844-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/24/2016] [Accepted: 10/23/2016] [Indexed: 11/24/2022]
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Abel MF, Singla A, Feger MA, Sauer LD, Novicoff W. Surgical treatment of Lenke 5 adolescent idiopathic scoliosis: Comparison of anterior vs posterior approach. World J Orthop 2016; 7:553-560. [PMID: 27672568 PMCID: PMC5027010 DOI: 10.5312/wjo.v7.i9.553] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/01/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the posterior vs anterior approaches for fusion of Lenke 5 adolescent idiopathic scoliosis curves, matched for curve magnitude and for the distal level of fixation (dLOF) standardized to the third lumbar vertebrae (L3).
METHODS A prospectively collected multicenter database was used for this retrospective comparative study. Our dependent variables included sagittal and coronal radiographic measurements, number of fused vertebrae, estimated blood loss, length of hospitalization and SRS total and individual domain scores at the two-year follow-up. Subject demographics were similar for all group comparisons. Independent t-test was used to compare groups for all analyses at P < 0.01.
RESULTS For all matched cases of Lenke 5 curves, a selective approach was used only 50% of the time in cases undergoing a posterior fusion. When comparing a posterior selective approach to an anterior selective approach, surgeons utilizing a posterior approach fused significantly more levels than surgeons using an anterior approach with no other significant differences in radiographic or SRS outcomes (Ant = 4.8 ± 1.0 levels vs post = 6.1 ± 1.0 levels, P < 0.0001). When the dLOF was standardized to L3, the anterior approached provided significantly greater lumbar Cobb percent correction than the posterior approach (Ant = 69.1% ± 12.6% vs post = 54.6% ± 16.4%, P = 0.004), with no other significant radiographic or SRS score differences between approaches.
CONCLUSION Surgeons treating Lenke 5c curves with a posterior instrumentation and fusion vs an anterior approach include more motion segments, even with a selective fusion. When controlled for the distal level of fixation, the anterior approach provides greater correction of the thoracolumbar curve.
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Adding-on Phenomenon After Surgery in Lenke Type 1, 2 Adolescent Idiopathic Scoliosis: Is it Predictable? Spine (Phila Pa 1976) 2016; 41:698-704. [PMID: 26630420 DOI: 10.1097/brs.0000000000001303] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to detect risk factors for Adding-on after posterior correction surgery in patients with Lenke 1 or 2 AIS, and to explore whether Adding-on Index could be used to predict Adding-on effectively. SUMMARY OF BACKGROUND DATA Adding-on phenomenon is a common complication in Lenke 1 or 2 AIS patients after correction surgery. However, whether it can be predicted after surgery remains unknown. METHODS Lenke 1 or 2 AIS patients receiving correction surgery in our center from January 2009 to July 2013 were analyzed. Antero-posterior and lateral films were evaluated before surgery, at 2 weeks' and 2 years' follow-up. Patients were divided into 2 groups according to whether Adding-on occurred at the 2 years' follow-up. Risk factors of Adding-on were analyzed, and Adding-on Index was proposed and verified. RESULTS Sixteen patients (16.3%) suffered from distal Adding-on at 2-year follow-up. Several parameters were found to be significantly different between 2 groups, including Risser's sign, postoperative Cobb angle of main thoracic, postoperative Cobb angle of main thoracic curve at 2-year follow-up, preoperative and postoperative Cobb angle of lumbar curve, postoperative Cobb angle of lumbar curve at 2-year follow-up, LIV-EV, LIV-SV, LIV-CSVL, LAV-CSVL, LAV-LIV, DnfS, and postoperative TJK. No significant differences in SRS-22 scores were observed. Binary logistic regression analysis showed that DnfS and postoperative residual Cobb angle of lumbar curve were primary factors for occurrence of Adding-on. According to the regression equation, Adding-on Index was defined as 4 × DnfS-postoperative lumbar curves Cobb angle. On the basis of ROC curve, if Adding-on Index was more than 12, the occurrence rate of Adding-on was 88%. On the contrary, the rate of no Adding-on phenomenon was 80%. CONCLUSION DnfS and posterior Cobb angle of lumbar curve were 2 important factors for Adding-on in Lenke 1, 2 AIS patients. Adding-on Index can be used to predict the occurrence of Adding-on effectively. LEVEL OF EVIDENCE 4.
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Studer D, Awais A, Williams N, Antoniou G, Eardley-Harris N, Cundy P. Selective fusion in adolescent idiopathic scoliosis: a radiographic evaluation of risk factors for imbalance. J Child Orthop 2015; 9:153-60. [PMID: 25845647 PMCID: PMC4417731 DOI: 10.1007/s11832-015-0653-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/27/2015] [Indexed: 02/03/2023] Open
Abstract
STUDY DESIGN Retrospective database, chart and medical imaging review. OBJECTIVES To report on the outcome and evaluate possible risk factors for postoperative complications following selective spinal fusion in patients with adolescent idiopathic scoliosis (AIS). MATERIALS AND METHODS All patients with AIS who underwent either a selective thoracic or selective thoracolumbar/lumbar spinal fusion at our institution from January 2001 to December 2011 inclusive were included in this study. The minimum postoperative follow-up period of all patients was 2 years. RESULTS During the 11-year study period, 157 patients with AIS underwent surgery for their progressive spinal deformity. Thirty patients (19 %) had a selective spinal fusion, with 16 patients (group A) having a selective thoracic, and 14 patients (group B) having a selective thoracolumbar/lumbar spinal arthrodesis. In both groups the main postoperative complications were adding-on (25 % group A, 36 % group B) and coronal decompensation (25 % group A, 29 % group B). In group A, no statistically significant risk factors for postoperative complications were identified. In group B, global coronal balance was identified as a significant risk factor for adding-on. Patients with adding-on had significantly higher coronal balance scores (mean 3.6) than those who did not experience adding-on (mean 1.9) (p = 0.03). In addition, those with adding-on had a significantly smaller bending lumbar Cobb angle (mean 15) than those without adding-on (mean 31.6) (p = 0.015). None of the patients who underwent selective spinal fusion required revision surgery. CONCLUSION Although the complication rate after performing a selective spinal fusion is high, the revision rate remains low and the debate whether or not to perform a selective spinal fusion will continue.
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Affiliation(s)
- D. Studer
- />Orthopaedic Department, University Children’s Hospital, PO Box 4031, Basel, Switzerland
| | - A. Awais
- />Orthopaedic Department, Women’s and Children’s Hospital, Adelaide, Australia
| | - N. Williams
- />Orthopaedic Department, Women’s and Children’s Hospital, Adelaide, Australia
| | - G. Antoniou
- />Orthopaedic Department, Women’s and Children’s Hospital, Adelaide, Australia
| | - N. Eardley-Harris
- />Orthopaedic Department, Women’s and Children’s Hospital, Adelaide, Australia
| | - P. Cundy
- />Orthopaedic Department, Women’s and Children’s Hospital, Adelaide, Australia
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Selective thoracic fusion in AIS curves: the definition of target outcomes improves the prediction of spontaneous lumbar curve correction (SLCC). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1263-81. [DOI: 10.1007/s00586-014-3280-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
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Siderakis N, Pardo Rosado J, Aguilar A, Dinelli D, Lutzky L, Reviriego J, Escalada M, Rositto G, Legarreta C. Analisis del balance coronal y último nivel artrodesado en escoliosis idiopática lenke 5: parámetros radiográficos específicos. COLUNA/COLUMNA 2013. [DOI: 10.1590/s1808-18512013000400006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Determinar las modificaciones postoperatorias que se producen en el balance coronal de los pacientes con escoliosis idiopática del adolescente (EIA) con curvas de Lenke tipo 5, realizando un análisis pre y postoperatorio de los siguientes parámetros radiológicos: último nivel vertebral artrodesado, inclinación de L4, traslación de vértebra apical, obliquidade lumbosacra, ángulo de Cobb y balance coronal previo. MÉTODOS: Se evaluaron 20 pacientes con diagnóstico de EIA con curvas de Lenke tipo 5, con un seguimiento promedio de 36 meses (R: 24 a 48). La edad promedio al momento de la cirugía fue de 15,3 años (R: 13 a 20 años), siendo la distribución por sexo de 16 mujeres y 4 hombres. RESULTADOS: En nuestra serie hemos detectado una correlación directa entre el AVTL y el LSTOA con el balance coronal postoperatorio, tanto en el grupo de los pacientes que mejoraron (14 pacientes), como en aquellos en los que el balance coronal empeoró (6 pacientes). CONCLUSIÓN: De la serie evaluada, fueron el AVTL y el LSTOA, los parámetros radiográficos específicos.
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Surgical treatment of Scheuermann's kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:180-91. [PMID: 23893052 DOI: 10.1007/s00586-013-2894-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 05/23/2013] [Accepted: 07/05/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION There is sparse literature on how best to correct Scheuermann's kyphosis (SK). The efficacy of a combined strategy with anterior release and posterior fusion (AR/PSF) with regard to correction rate and outcome is yet to be determined. MATERIALS AND METHODS A review of a consecutive series of SK patients treated with AR/PSF using pedicle screw-rod systems was performed. Assessment of demographics, complications, surgical parameters and radiographs including flexibility and correction measures, proximal junctional kyphosis angle (JKA + 1) and spino-pelvic parameters was performed, focusing on the impact of curve flexibility on correction and clinical outcomes. RESULTS 111 patients were eligible with a mean age of 23 years, follow-up of 24 months and an average of eight levels fused. Cobb angle at fusion level was 68° preoperatively and 37° postoperatively. Flexibility on traction films was 34 % and correction rate 47 %. Postoperative and follow-up Cobb angles were highly correlated with preoperative bending films (r = 0.7, p < 0.05). Screw density rate was 87 %, with increased correction with higher screw density (p < 0.001, r = 0.4). Patients with an increased junctional kyphosis angle (JKA + 1) were at higher risk of revision surgery (p = 0.049). 22 patients sustained complication, and 21 patients had revision surgery. 42 patients with ≥24 months follow-up were assessed for clinical outcomes (follow-up rate for clinical measures was 38 %). This subgroup showed no significant differences regarding baseline parameters as compared to the whole group. Median approach-related morbidity (ArM) was 8.0 %, SRS-sum score was 4.0, and ODI was 4 %. There was a significant negative correlation between the SRS-24 self-image scores and the number of segments fused (r = -0.5, p < 0.05). Patients with additional surgery had decreased clinical outcomes (SRS-24 scores, p = 0.004, ArM, p = 0.0008, and ODI, p = 0.0004). CONCLUSION The study highlighted that AR/PSF is an efficient strategy providing reliable results in a large single-center series. Results confirmed that flexibility was the decisive measure when comparing surgical outcomes with different treatment strategies. Findings indicated that changes at the proximal junctional level were impacted by individual spino-pelvic morphology and determined by the individually predetermined thoracolumbar curvature and sagittal balance. Results stressed that in SK correction, reconstruction of a physiologic alignment is decisive to achieving good clinical outcomes and avoiding complications.
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Izatt MT, Adam CJ, Verzin EJ, Labrom RD, Askin GN. CT and radiographic analysis of sagittal profile changes following thoracoscopic anterior scoliosis surgery. SCOLIOSIS 2012; 7:15. [PMID: 22913616 PMCID: PMC3495407 DOI: 10.1186/1748-7161-7-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/10/2012] [Indexed: 12/02/2022]
Abstract
Background Previous studies report an increase in thoracic kyphosis after anterior approaches and a flattening of sagittal contours following posterior approaches. Difficulties with measuring sagittal parameters on radiographs are avoided with reformatted sagittal CT reconstructions due to the superior endplate clarity afforded by this imaging modality. Methods A prospective study of 30 Lenke 1 adolescent idiopathic scoliosis (AIS) patients receiving selective thoracoscopic anterior spinal fusion (TASF) was performed. Participants had ethically approved low dose CT scans at minimum 24 months after surgery in addition to their standard care following surgery. The change in sagittal contours on supine CT was compared to standing radiographic measurements of the same patients and with previous studies. Inter-observer variability was assessed as well as whether hypokyphotic and normokyphotic patient groups responded differently to the thoracoscopic anterior approach. Results Mean T5-12 kyphosis Cobb angle increased by 11.8 degrees and lumbar lordosis increased by 5.9 degrees on standing radiographs two years after surgery. By comparison, CT measurements of kyphosis and lordosis increased by 12.3 degrees and 7.0 degrees respectively. 95% confidence intervals for inter-observer variability of sagittal contour measurements on supine CT ranged between 5-8 degrees. TASF had a slightly greater corrective effect on patients who were hypokyphotic before surgery compared with those who were normokyphotic. Conclusions Restoration of sagittal profile is an important goal of scoliosis surgery, but reliable measurement with radiographs suffers from poor endplate clarity. TASF significantly improves thoracic kyphosis and lumbar lordosis while preserving proximal and distal junctional alignment in thoracic AIS patients. Supine CT allows greater endplate clarity for sagittal Cobb measurements and linear relationships were found between supine CT and standing radiographic measurements. In this study, improvements in sagittal kyphosis and lordosis following surgery were in agreement with prior anterior surgery studies, and add to the current evidence suggesting that anterior correction is more capable than posterior approaches of addressing the sagittal component of both the instrumented and adjacent non instrumented segments following surgical correction of progressive Lenke 1 idiopathic scoliosis.
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Affiliation(s)
- Maree T Izatt
- Paediatric Spine Research Group, Queensland University of Technology and Mater Health Services Brisbane Ltd, Queensland, Australia.
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