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

Yeung, Kwong Hang; Man, Gene Chi Wai; Skalli, Wafa; Hu, Zongshan; Hung, Vivian Wing Yin; Hung, Alec Lik-Hang; Lam, Tsz Ping; Ng, Bobby Kin Wah; Cheng, Jack Chun Yiu; Vergari, Claudio

doi:10.1038/s41598-021-85782-6

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…In a multivariate analysis of 371 subjects, Pasha et al [70,71] found that preoperative clusters, which shared significant differences in TK, predicted three clusters of 3D surgical outcomes with an accuracy of 64%. Regarding global alignment, Yeung et al [72] reported that hypokyphotic patients had adopted a more forwardleaning posture to compensate for global sagittal imbalance (indicated by SVA-SFD and sagittal OD-HA) compared to normokyphotic adolescent idiopathic scoliosis (AIS) subjects. However, this improved from immediate post-op to the 2-year postoperative follow-up.…”

Section: Sagittal Alignmentmentioning

confidence: 99%

Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

Wan

Wong

et al. 2023

Eur Spine J

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Background Restoration of three-dimensional (3D) alignment is critical in correcting patients with adolescent idiopathic scoliosis using posterior spinal fusion (PSF). However, current studies mostly rely on 2D radiographs, resulting in inaccurate assessment of surgical correction and underlying predictive factors. While 3D reconstruction of biplanar radiographs is a reliable and accurate tool for quantifying spinal deformity, no study has reviewed the current literature on its use in evaluating surgical prognosis. Purpose To summarize the current evidence on patient and surgical factors affecting sagittal alignment and curve correction after PSF based on 3D parameters derived from reconstruction of biplanar radiographs. Methods A comprehensive search was conducted by three independent investigators on Medline, PubMed, Web of Science, and Cochrane Library to obtain all published information on predictors of postoperative alignment and correction after PSF. Search items included "adolescent idiopathic scoliosis," "stereoradiography," "three-dimensional," "surgical,” and "correction." The inclusion and exclusion criteria were carefully defined to include clinical studies. Risk of bias was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development, and Evaluations approach. 989 publications were identified, with 444 unique articles subjected to full-text screening. Ultimately, 41 articles were included. Results Strong predictors of better curve correction included preoperative normokyphosis (TK > 15°), a corresponding rod contour, intraoperative vertebral rotation and translation, and upper and lower instrumented vertebrae selected based on sagittal and axial inflection points. For example, for Lenke 1 patients with junctional vertebrae above L1, fusion to NV-1 (1 level above the neutral vertebra) achieved optimal curve correction while preserving motion segments. Pre-op coronal Cobb angle and axial rotation, distal junctional kyphosis, pelvic incidence, sacral slope, and type of instrument were identified as predictors with moderate evidence. For Lenke 1C patients, > 50% LIV rotation was found to increase spontaneous lumbar curve correction. Pre-op thoracolumbar apical translation and lumbar lordosis, Ponte osteotomies, and rod material were found to be predictors with low evidence. Conclusions Rod contouring and UIV/LIV selection should be based on preoperative 3D TK in order to achieve normal postoperative alignment. Specifically, Lenke 1 patients with high-lying rotations should be fused distally at NV-1, while hypokyphotic patients with large lumbar curves and truncal shift should be fused at NV to improve lumbar alignment. Lenke 1C curves should be corrected using > 50% LIV rotation counterclockwise to the lumbar rotation. Further investigation should compare surgical correction between pedicle-screw and hybrid constructs using matched cohorts. DJK and overbending rods are potential predictors of postoperative alignment.

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Section: Sagittal Alignmentmentioning

confidence: 99%

Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

Wan

Wong

et al. 2023

Eur Spine J

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“…Making full use of the potential of EOS imaging system, Amabile et al proposed a new 3D parameter: the odontoid-hip axis (OD-HA) angle to quantify the 3D headpelvis alignment in young asymptomatic adults (12). Further studies showed that this parameter was quasi-invariant in a large part of the population, including older adults, both Caucasian and Chinese, and adolescent idiopathic scoliosis patients before and after surgery (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

An analysis on the determinants of head to pelvic balance in a Chinese adult population

Hu¹,

Vergari²,

Gajny³

et al. 2022

Quant Imaging Med Surg

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Background: Balanced global spinopelvic balance is important in the maintenance of the physiological alignment of all body segments above the pelvis with minimum energy expenditure. The key determinants affecting the 3D index-odontoid-hip axis (OD-HA) angle, and in particular its alterations, have not been clearly defined. The aim of this study is to identify the determinants of the 3D OD-HA angle in maintaining global spinopelvic balance in a large Chinese adult cohort of different gender and age groups.Methods: A total of 516 asymptomatic adults were enrolled in this study. Biplanar radiographies were performed to reconstruct the subject's inter-acetabular axis and C2 odontoid process. The 3D angle formed by the vertical and the line between odontoid and mid-interacetabular axis (OD-HA angle) was computed and projected in the subject's sagittal and coronal planes. Thoracic kyphosis (TK), lumbar lordosis (LL), T1 pelvic angle (TPA) and sagittal vertical axis (SVA) were measured. Results:The mean values of sagittal and coronal OD-HA were −0.2°±2.5° and 0.2°±1.1°, respectively.Both sagittal and coronal OD-HA had significant correlation with age (r=0.265 and r=−0.143, P<0.01, respectively), sagittal OD-HA showed increment from 20s to 80s (−1.3° to 0.8° for female, −0.3° to 1.5° for male) and a significant difference between male and female from 20 to 69 years old. Further analysis showed that sex, weight, TK, PT, SVA, TPA and ODI were determinants of OD-HA.Conclusions: 3D OD-HA angle showed physiological stability with little variability from young to elderly adults, with SD of 2.45° and 1.06° in sagittal and coronal planes, respectively. OD-HA angle confirms the hypothesis that the head tends to remain above the pelvis in a small cone of stability. This study provides an analysis of the determinants of OD-HA and the reference range of the head-pelvis balance in each decade and gender based on a large-scale asymptomatic population.

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“…For example, BPXR is used to follow up patients with idiopathic scoliosis treated with the in-brace method [ 9 ]. In patients with scoliosis, numerous X-ray images are taken to follow the patient’s growth or the impact of the treatment on the spine alignment [ 10 , 11 , 12 ]. With low irradiation, BPRX provides a useful tool for the radiological follow-up of patients with spinal deformities, especially children.…”

Section: Introductionmentioning

confidence: 99%

Biplanar Low-Dose Radiograph Is Suitable for Cephalometric Analysis in Patients Requiring 3D Evaluation of the Whole Skeleton

Kerbrat

Rivals

Dupuy

et al. 2021

JCM

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Background: The biplanar 2D/3D X-ray technology (BPXR) is a 2D/3D imaging system allowing simultaneous stereo-corresponding posteroanterior (PA) and lateral 2D views of the whole body. The aim of our study was to assess the feasibility of cephalometric analysis based on the BPXR lateral skull view to accurately characterize facial morphology. Method: A total of 17 landmarks and 11 angles were placed and/or calculated on lateral BPXR and lateral cephalograms of 13 patients by three investigators. Five methods of angle identification were performed: the direct construction of straight lines on lateral cephalograms (LC-A) and on BPXR (BPXR-A), as well as the calculation of angles based on landmark identification on lateral cephalograms (LA-L) and on BPXR with the PA image (BPXR-LPA) or without (BPXR-L). Intra- and interoperator reliability of landmark identification and angle measurement of each method were calculated. To determine the most reliable method among the BPXR-based methods, their concordance with the reference method, LC-A, was evaluated. Results: Both imaging techniques had excellent intra- and interoperator reliability for landmark identification. On lateral BPXR, BPXR-A presented the best concordance with the reference method and a good intra- and interoperator reliability. Conclusion: BPXR provides a lateral view of the skull suitable for cephalometric analysis with good reliability.

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

Cited by 5 publications

References 30 publications

Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

An analysis on the determinants of head to pelvic balance in a Chinese adult population

Biplanar Low-Dose Radiograph Is Suitable for Cephalometric Analysis in Patients Requiring 3D Evaluation of the Whole Skeleton

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