Correction of rotational deformity and restoration of thoracic kyphosis are inversely related in posterior surgery for adolescent idiopathic scoliosis

Acaroğlu, Emre; Doany, Michael E.; Çetin, Engin; Castelein, René M.

doi:10.1016/j.mehy.2019.109396

Cited by 10 publications

(11 citation statements)

References 34 publications

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“…Comparison of the pre-and postoperative shape of the main thoracic curve between three different 'schools' for scoliosis surgery supports the hypothesis that significant coronal and axial correction tends to go at the detriment of the sagittal plane correction, and vice versa [13,15]. From the AIS pathoanatomy follows that with greater coronal correction and axial derotation, there is relative anterior lengthening of the spine because the apical lordosis is derotated to the midsagittal plane.…”

Section: Discussionmentioning

confidence: 55%

“…In an attempt to surgically correct the coronal deviation and axial rotation, the additional anterior length, that has 'escaped' to the side, is rotated back to the midline, creating a thoracic hypokyphosis/lordosis at the level of the apex. The hypothesis by Acaroglu et al has recently been confirmed by Hershkovitz et al: They demonstrated that significant correction in the coronal plane is associated with postoperative hypokyphosis [13,15]. Therefore, less significant coronal or axial correction may be required to achieve more kyphosis restoration.…”

Section: Introductionmentioning

confidence: 91%

“…1) [9][10][11][12]. Recently, Acaroglu et al hypothesized that, due to an intrinsic component of AIS, posterior surgery cannot correct all three planes at the same time [13]. The anterior aspect of the rotated apex is longer than the posterior column in AIS.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of different strategies on three-dimensional correction of AIS: which plane will suffer?

et al. 2020

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Purpose There are distinct differences in strategy amongst experienced surgeons from different ‘scoliosis schools’ around the world. This study aims to test the hypothesis that, due to the 3-D nature of AIS, different strategies can lead to different coronal, axial and sagittal curve correction. Methods Consecutive patients who underwent posterior scoliosis surgery for primary thoracic AIS were compared between three major scoliosis centres (n = 193). Patients were treated according to the local surgical expertise: Two centres perform primarily an axial apical derotation manoeuvre (centre 1: high implant density, convex rod first, centre 2: low implant density, concave rod first), whereas centre 3 performs posteromedial apical translation without active derotation. Pre- and postoperative shape of the main thoracic curve was analyzed using coronal curve angle, apical rotation and sagittal alignment parameters (pelvic incidence and tilt, T1–T12, T4-T12 and T10-L2 regional kyphosis angles, C7 slope and the level of the inflection point). In addition, the proximal junctional angle at follow-up was compared. Results Pre-operative coronal curve magnitudes were similar between the 3 cohorts and improved 75%, 70% and 59%, from pre- to postoperative, respectively (P < 0.001). The strategy of centres 1 and 2 leads to significantly more apical derotation. Despite similar postoperative T4-T12 kyphosis, the strategy in centre 1 led to more thoracolumbar lordosis and in centre 2 to a higher inflection point as compared to centre 3. Proximal junctional angle was higher in centres 1 and 2 (P < 0.001) at final follow-up. Conclusion Curve correction by derotation may lead to thoracolumbar lordosis and therefore higher risk for proximal junctional kyphosis. Focus on sagittal plane by posteromedial translation, however, results in more residual coronal and axial deformity.

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 91%

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Comparison of different strategies on three-dimensional correction of AIS: which plane will suffer?

et al. 2020

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“…The surgeons of this article observed cases of thoracic hyperkyphosis operated using convergent screws showing very satisfactory correction in the coronal planes was not the focus, more recent techniques have been centered on three-dimensional balance and correction in the coronal, sagittal, and axial planes. 13 Karimi et al, recommend using a combination of transversal and vertical forces to correct scoliosis without significant collateral effects in the sagittal plane. 14 Regarding the sagittal plane, monoaxial screws, when adjusted to the rods, lock at 90°.…”

Section: Discussionmentioning

confidence: 99%

“…A slight imbalance was observed in the sagittal plane of the spine, mainly in the cases that presented previous hypokyphosis, however they stated that more studies are necessary. 13 To evaluate and determine the efficacy of several configurations of forces in the correction of three-dimensional spinal deformities, a 3D model of the spine was developed based on computed tomography images obtained from a scoliotic girl. The model was exported to Abaquas software to verify the effects of several configurations of force and magnitudes in the correction of spinal curvatures.…”

Section: Introductionmentioning

confidence: 99%

Correction of the Spinal Sagittal Plane: The Application of Convergent or Divergent Screws

Garcia

Júnior³

et al. 2020

Coluna/Columna

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Objective To present a new principle for correction of the sagittal plane of the spine through the convergent or divergent placement of monoaxial pedicle screws in this plane, associated with compression or distraction, to provide lordotizing or kyphotizing leverage force. Method A statistical mechanical study of twenty-eight fixations in synthetic spine segments was performed. In fifteen pieces, pedicle screws were applied to the ends of the segments with positioning convergent to the center of the fixation. They were attached to the straight rods and subjected to compression force. The other thirteen segments were fixed with pedicle screws in a direction divergent to the center of the fixation, attached to the straight rods, and subjected to distraction force. Results To create kyphosis in the 15 synthetic segments of the spine, the mean pre-fixation Cobb angle was - 0.7° and the mean post-fixation angle was +15°. To create lordosis in the 13 segments, the mean pre-fixation Cobb angle was +1° and the mean post-fixation angle was +18°. The difference was confirmed by statistical mechanical tests and considered significant. However, there is no relevant difference between the mean angles for lordosis and kyphosis formation. Conclusions It was concluded that the correction of the sagittal plane of the spine by applying the new instrumentation method is efficient. A statistical mechanical test confirmed that the difference in Cobb degrees between pre- and post-fixation of the synthetic spine segments was considered significant in the creation of both kyphosis and lordosis. Level of evidence II C; Statistical mechanical study of synthetic spine segments.

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Rod Link Reducer system in adolescent idiopathic scoliosis: a retrospective observational trial

Balsano¹,

Vacchiano²,

Bagnis

et al. 2022

International Orthopaedics (SICOT)

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Correction of rotational deformity and restoration of thoracic kyphosis are inversely related in posterior surgery for adolescent idiopathic scoliosis

Cited by 10 publications

References 34 publications

Comparison of different strategies on three-dimensional correction of AIS: which plane will suffer?

Comparison of different strategies on three-dimensional correction of AIS: which plane will suffer?

Correction of the Spinal Sagittal Plane: The Application of Convergent or Divergent Screws

Rod Link Reducer system in adolescent idiopathic scoliosis: a retrospective observational trial

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