Assessment of Trunk Balance in Thoracic Scoliosis

Richards, B. Stephens; Scaduto, Anthony A.; Vanderhave, Kelly L.; Browne, Richard

doi:10.1097/01.brs.0000170298.89145.b4

Cited by 40 publications

(23 citation statements)

References 21 publications

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“…However, their findings were only reliable in patients with marked coronal imbalance, which does not happen to be the case for the majority of patients with AIS [6]. Although Luk et al [10] measured postoperative trunk shift in patients with Lenke type 1 curves, the authors did not further analyze their data in regard to prevalence, incidence, or risk factors for postoperative decompensation.…”

Section: Discussionmentioning

confidence: 91%

“…Numerous studies have used the C7P-CSVL distance as an outcome tool for coronal balance after surgical treatment for AIS [3][4][5][6][7], but there is a paucity of data commenting on the postoperative trunk balance and/or trunk shift in AIS. The purpose of this study is to analyze postoperative trunk balance in AIS patients with a Lenke type 1 or 2 curve from a prospective multicenter database.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative trunk shift in Lenke 1 and 2 curves: how common is it? and analysis of risk factors

et al. 2011

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The goal of surgical treatment for adolescent idiopathic scoliosis (AIS) is to achieve a solid fusion in a balanced spine. While many previous studies analyzed coronal balance, there is a paucity of studies that comment on postoperative trunk shift, which has shown to have impact on clinical outcome. The purpose of this retrospective, multicenter data analysis was to analyze the incidence of postoperative trunk shift in patients with surgical treatment for AIS. We conducted a retrospective, multicenter data analysis of 1,555 patients with AIS. Patients with a Lenke type 1 or 2 curve pattern and a minimum follow-up of 24 months after surgery were included. A [2 cm deviation of the trunk in relation to the pelvis was considered positive trunk shift. A subanalysis was performed to identify potential risk factors for trunk shift. 273 patients meeting the inclusion criteria were analyzed. While the preoperative prevalence of trunk shift was surgically reduced from 29.3 to 13.6%, 24 patients (8.8%) with postoperative trunk shift had not had preoperative trunk shift, and the trunk shift was considered iatrogenic. Undercorrection of the lumbar curve was identified as potential risk factor, whereas thoracic correction, coronal balance, angulation and translation of the lowest instrumented vertebra did not seem to influence postoperative trunk shift. Iatrogenic postoperative trunk shift has an incidence of 8.8% in the surgical treatment of AIS.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Postoperative trunk shift in Lenke 1 and 2 curves: how common is it? and analysis of risk factors

et al. 2011

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“…The position of the thorax may be evaluated with 2 methods, the measurement of lateral trunk shift or the apical vertebra translation. In their study, Richards et al17) have evaluated the relation among lateral trunk shift, thoracic apical vertebra translation, and the coronal balance. They have reported that the sum of coronal balance and the apical vertebra translation is related with lateral trunk shift.…”

Section: Discussionmentioning

confidence: 99%

“…Ideally, the lowest instrumented vertebra should be as proximal as possible to preserve lumbar motion, but it should be distal enough to avoid trunk imbalance. The level of the lowest instrumented vertebra and the amount of sufficient correction are still controversial8141720). It is also uncertain if coronal imbalance may develop in a spinal column, totally corrected with a short segment fusion.…”

Section: Introductionmentioning

confidence: 99%

The Surgical Overcorrection of Lenke Type 1 Deformities with Selective Fusion Segments: What Happens to the Coronal Balance?

Atıcı¹,

Erdoğan

Akman

et al. 2016

Korean J Spine

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PurposeThe aim of our study is to determine the alterations on coronal balance after overcorrection of Lenke type 1 curve, retrospectively.MethodsDatas of 34 patients (29 female, 5 male patients; mean age, 16.3±3.3 years; range, 13-24 years) surgically treated for scoliosis between 2004 and 2010 were reviewed, retrospectively. The adolescent idiopathic scoliosis patients with Lenke type 1 curve treated with only posterior pedicle screw and postoperative thoracic curves less than 10° by Cobb method on frontal plane were enrolled in this study. Mean follow-up period was 52.5±29.7 months.ResultsThe mean amount of the preoperative thoracic curves was measured as 41.2°±6.1° (range, 30°-56°). The mean amount of the early postoperative thoracic curves was measured as 6.5°±1.8° (range, 3°-9°). The mean amount of the thoracic curves was measured as 8.5°±4.6° (range, 3°-22°) during the last follow-up (p=0.01). The mean preoperative coronal balance was measured as 8.5mm(range, 1-30mm). The mean early postoperative coronal balance was measured as 3.5mm(range, 0-36 mm). The mean coronal balance was measured as 5.5mm(range, 0-38mm) during the last follow-up (p>0.05).ConclusionWe suggest that Lenke type 1B and 1C should be carefully evaluated and the fusion levels should be accurately selected in order to maintain the correction of coronal balance. We suggest that selective fusion with overcorrection in Lenke type 1A are applied to curves that can be corrected lumbar curve at the preoperative bending radiograph and curves that not have coronal decompensation and >10° distal junctional kyphosis, preoperatively.

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“…Traditionally, coronal balance (CB) is measured and quantified by the perpendicular distance between the coronal C7 plumbline (C7PL) and the central sacral vertical line (CSVL), with a value [20 mm being defined as imbalance [4]. Numerous studies have used the C7PL-CSVL distance as an assessment tool for surgical outcomes of AIS [5][6][7][8], but there is a paucity of data specifically addressing the postoperative CB in AIS [9], especially the ultimate CB after a long period of follow-up.…”

Section: Introductionmentioning

confidence: 99%

Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion

et al. 2013

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Purpose To investigate which pre-and postoperative radiographic parameters are significantly correlated with the immediate postoperative coronal balance (CB) in Lenke 5C AIS patients, and to identify any radiographic parameter that is correlated with the ultimate CB at a minimum follow-up of 2 years. Methods Forty Lenke 5C AIS patients were recruited in the current study. Preoperative, immediate postoperative, and the latest follow-up radiographs were reviewed measuring various radiographic parameters related to UIV and LIV. The correlations between different parameters and CB were then studied. Results The average follow-up time was 35.2 months. Correlation analysis showed that the following radiographic parameters significantly associated with the immediate postoperative CB in Lenke 5C patients: preoperative CB (r = 0.66, p \ 0.01), preoperative UIV translation (r = 0.61, p \ 0.01), preoperative LIV tilt (r = 0.61, p \ 0.01), postoperative UIV translation (r = 0.51, p \ 0.05), and postoperative LIV tilt (r = 0.50, p \ 0.05). At the last follow-up, only the final UIV tilt was inversely correlated with the ultimate CB (r = -0.58, p \ 0.05). Seven patients presented with coronal imbalance immediately after surgery. However, only one of the seven patients presented with coronal imbalance at the last follow-up, and

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Assessment of Trunk Balance in Thoracic Scoliosis

Abstract: In patients with thoracic idiopathic scoliosis, if the CB and thoracic AVT values are known, then the LTS can be reliably estimated. The use of correct terminology for describing trunk balance and CB is important if valid comparisons of spinal deformity literature are desired.

Cited by 40 publications

References 21 publications

Postoperative trunk shift in Lenke 1 and 2 curves: how common is it? and analysis of risk factors

Postoperative trunk shift in Lenke 1 and 2 curves: how common is it? and analysis of risk factors

The Surgical Overcorrection of Lenke Type 1 Deformities with Selective Fusion Segments: What Happens to the Coronal Balance?

Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion

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