Cervical Spine Compensation in Adolescent Idiopathic Scoliosis

Norheim, Elizabeth P.; Carreon, Leah Y.; Sucato, Daniel J.; Lenke, Lawrence G.; Dankowski, Aygul B.; Glassman, Steven D.

doi:10.1016/j.spinee.2014.08.097

Cited by 7 publications

(8 citation statements)

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“…c Type 3 lengthen caudally thoracic kyphosis to restore the proper length of TK and reposition the inflection point between T12 and L1 by straightening the TL junction Fig. 3 (continued) sagittal correction [9,15,[20][21][22]. In healthy subjects, especially in children and adolescents, we showed strong correlations between the behavior of the cervical spine and the orientation of the upper segment of the thoracic spine materialized by C7 or T1 slope [23].…”

Section: Spearman Correlation Testmentioning

confidence: 74%

Sagittal classification in adolescent idiopathic scoliosis: original description and therapeutic implications

Abelin-Genevois¹,

Sassi²,

Verdun

et al. 2018

Eur Spine J

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This new classification summarizes all the pathological scenarios of the sagittal alignment of AIS into four patterns. A specific surgical planning can be extrapolated for each pattern. In type 1, the objective is to preserve the sagittal shape. In type 2, the objective is to restore thoracic kyphosis. In type 2b, TL junction should be straightened. In type 3, the objective is to reshape the lower arc of thoracic sagittal angle and straighten the TL junction. These slides can be retrieved under Electronic Supplementary Material.

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Section: Spearman Correlation Testmentioning

confidence: 74%

Sagittal classification in adolescent idiopathic scoliosis: original description and therapeutic implications

Abelin-Genevois¹,

Sassi²,

Verdun

et al. 2018

Eur Spine J

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“…Therefore, the global spine alignment including the head should be considered during the surgical planning of posterior instrumentation. Type 1 and type 2 Lenke curves are associated with abnormal thoracic sagittal alignment, but it has been shown that thoracic hypokyphosis and cervical hypolordosis, often observed in AIS, can be improved postoperatively [6] [7] [8]. Patients with thoracic hypokyphosis usually compensate with cervical hypolordosis.…”

Section: Introductionmentioning

confidence: 99%

Global Sagittal Alignment and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis

et al. 2019

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Study design: Case-Control Study Objectives: To analyse global sagittal alignment including the cranial center of mass (CCOM) and proximal junctional kyphosis (PJK) in Adolescent Idiopathic Scoliosis (AIS) patients treated with posterior instrumentation. Summary of background data: PJK plays an important role in the global sagittal alignment in AIS patients. Maintaining the head above the pelvis allows for a minimization of energy expense in ambulation and upright posture. Numerous studies have been performed to understand PJK phenomena in AIS patients. However, to our knowledge, no study performed on AIS patients included the head in the analysis of global sagittal alignment and PJK. Methods: This study included 85 AIS patients and 51 asymptomatic adolescents. Low-dose bi-planar X-rays were acquired for each subject preoperatively and at two years follow up. Two global sagittal alignment parameters were calculated, i.e. the angle between the vertical and the line joining the center of the bi-coxofemoral axis (HA) and either the most superior point of the dentiform apophysis of C2 (OD) or the cranial center of mass (CCOM). Results: Among normal adolescents, the average OD-HA and CCOM-HA angles were-2.3°±2° and-1.5°±1.8°, respectively. Among AIS patients the average OD-HA and CCOM-HA angles were respectively-2.3°±1.9° and-1.3°±1.8° preoperatively and-2.8°±1.7° and-1.9°±1.7° at the last follow up. 13% of the patients developed PJK postoperatively. Case-bycase analysis showed that adjusting the thoracic kyphosis and the compensations required to maintain this constant could provide explanatory elements. Conclusions: OD-HA and CCOM-HA angles remain almost constant among normal group and patients, pre-and post-operatively, whether PJK or non-PJK. Five patients without PJK and only one patient with PJK produced abnormal values relative to the asymptomatic subjects. Therefore, PJK could be a compensation mechanism, which allows for CCOM-HA and, to a lesser extent, OD-HA to remain invariant.

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“…Most of these previous studies included patients of all curve types and ignored its potential influence on cervical alignment. [ 12 ] Moreover, the previous studies lack long-term follow-up and failed to evaluate the remodeling process of CSA during the follow-up period. Additionally, as the CSA may have an effect on patients’ long-term outcome, [ 13 – 15 ] it would be of importance to seek predictive factors of the ultimate CSA, which has not been reported.…”

Section: Introductionmentioning

confidence: 99%

Predictors of ultimate postoperative cervical sagittal alignment in main thoracic adolescent idiopathic scoliosis

et al. 2017

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This is a retrospective study. The aim of this study was to access sagittal compensatory mechanism of the cervical spine in thoracic adolescent idiopathic scoliosis (T-AIS) before and after posterior spinal fusion and to identify preoperative or immediate postoperative radiographic parameters that can predict the ultimate cervical sagittal alignment (CSA) after long-term follow-up.A retrospective study was performed on 44 T-AIS patients treated with posterior spinal fusion and with at least 5 years of follow-up. Preoperative, immediate postoperative and latest follow-up radiographs were reviewed measuring cervical lordosis (CL), cervical sagittal vertical axis (CSVA), upper thoracic kyphosis (UTK), main thoracic kyphosis (MTK), global thoracic kyphosis (GTK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Pearson correlation analysis, stepwise multilinear regression analysis, and receiver operator characteristic (ROC) curve were performed to define the relationship between ultimate CL and preoperative or immediate postoperative radiographic parameters.CL significantly improved from 6.6 ± 8.8 degree kyphosis preoperatively to 3.8 ± 8.7 degree kyphosis immediate postoperatively and to 0.5 ± 7.3 degree lordosis at the latest follow-up. Pre- and postoperative CSVA showed no significant difference. Pearson correlation coefficient test showed that CL was only correlated to T1 slope and UTK before surgery, whereas it was correlated to T1 slope, UTK, and GTK after surgery. The following equation was developed to estimate the ultimate CL: ultimate CL = −2.792 + 0.510 × Preop CL + 0.531 × Postop T1 slope. Furthermore, ROC curve showed that preoperative CL ≥−4.5 degree was strongly predictive and postoperative T1 slope ≥11.3 degree was moderately predictive of lordotic cervical spine after long-term follow-up.For T-AIS patients, CL significantly increased after surgery with the restoration of the global and regional sagittal profile. The sagittal compensatory mechanism of the cervical spine before surgery is different from that after surgery. In these patients, preoperative CL and immediate postoperative T1 slope could be predictors of the ultimate CSA after long-term follow-up.

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Cervical Spine Compensation in Adolescent Idiopathic Scoliosis

Cited by 7 publications

References 0 publications

Sagittal classification in adolescent idiopathic scoliosis: original description and therapeutic implications

Sagittal classification in adolescent idiopathic scoliosis: original description and therapeutic implications

Global Sagittal Alignment and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis

Predictors of ultimate postoperative cervical sagittal alignment in main thoracic adolescent idiopathic scoliosis

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