Predictability of the spontaneous lumbar curve correction after selective thoracic fusion in idiopathic scoliosis

Jansen, Rebecca; Rhijn, Lodewijk W. van; Duinkerke, Eric; Ooij, André van

doi:10.1007/s00586-007-0320-3

Cited by 54 publications

(27 citation statements)

References 18 publications

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“…In addition, the aggravation of the secondary curve may also contribute to the curve pattern changes, such as from single thoracic to double major curve. Many authors assume that as scoliosis is developing, the vertebral column tries to rebuild a new balance [12,[32][33][34]. Thus, in thoracic AIS, a lumbar curve develops to compensate for the deviation of the thoracic vertebrae to reconstruct the balance of the trunk.…”

Section: Discussionmentioning

confidence: 99%

Evolution of the curve patterns during brace treatment for adolescent idiopathic scoliosis

et al. 2012

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Summary of background data The curve pattern of idiopathic scoliosis is important for making decisions concerning bracing. However, whether the curve pattern changes during brace treatment have not been fully documented. The aim of this study was to investigate the changes of curve pattern during brace treatment in skeletally immature patients with adolescent idiopathic scoliosis (AIS). MethodsFrom January 2002 to January 2011, AIS patients treated with a Boston or Milwaukee brace were recruited after meeting the following inclusion criteria: older than 10 years of age at initiation of bracing; having a Cobb angle of 25°-40°; with a Risser sign 0-2; being regularly followed until the weaning of brace or the necessity of surgical treatment; and without history of previous treatment. A total of 130 female and 11 male AIS patients were included. The mean age was 12.9 years at initiation of bracing, and the female patients were, on average, 2.7 months past menarche. The mean follow-up period was 2.6 years (range 1.0-5.5 years). The definitions of changes in curve patterns were divided into four categories as follows: (1) shift of the apex of the main curve; (2) change in the curve span of more than two vertebrae; (3) change in the main curve type with regard to the apex location; and (4) change of curve direction. The patients were divided into two groups. Group A was comprised of patients who had experienced one or more categories of curve pattern changes, and Group B was comprised of those who had not. Results Of these 39 patients, 14 had apex shifting, 2 underwent curve span changes, 22 experienced changes in the main curve type, and one female had both changes in the apex and curve span. At the initiation of bracing, patients in Group A demonstrated significantly lower menarchal status (P = 0.018) and lower Risser grade (P = 0.025) than those in Group B. The difference in the percentage of patients who underwent Boston bracing between the two groups was statistically significant (41.5 % for Group A vs. 24.0 % for Group B, P = 0.023). Conclusion Changes in curve pattern can occur during brace treatment. Patients with less skeletal maturity and those treated with a Boston brace are more susceptible to this phenomenon.

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Section: Discussionmentioning

confidence: 99%

Evolution of the curve patterns during brace treatment for adolescent idiopathic scoliosis

et al. 2012

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“…The surgical procedure was conducted under general anesthesia in prone position using a Jackson table and under neuro-monitoring surveillance (SSEP and MEP). Posterior instrumented fusion was performed according to a protocol previously described [13] and summarized hereafter. After posterior exposure of the spine, an hybrid construct was systematically applied including: pedicular screws in the caudal area between T11 and the lower instrumented vertebra (superior or equal to L2); sub-laminar hooks in compression in the cranial area, two 5.5 mm titanium rods, and sublaminar bands (Universal Clamp, Zimmer, Bordeaux) on 3-6 levels on the concavity of the deformity and 1 or 2 on the convexity for stabilization purpose.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

et al. 2012

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Purpose Surgical adolescent idiopathic scoliosis (AIS) management can be associated with loss of thoracic kyphosis and a secondary loss of lumbar lordosis leading to iatrogenic flatback. Such conditions are associated with poorer clinical outcomes during adulthood. The aim of this study was to evaluate sagittal plane reciprocal changes after posterior spinal fusion in the setting of AIS. Methods Thirty consecutive adolescents (mean age 14.6 years) with AIS Lenke 1, 2 or 3 were included in this retrospective study with 2 year follow-up. Full-spine standing coronal and lateral radiographs were obtained preoperatively, at 3 and 24 months postoperatively. Coronal Cobb angle, thoracic kyphosis (TK) and lumbar lordosis (LL) were measured. Surgical procedure was similar in all the cases, with use of pedicular screws between T11 and the lowest instrumented vertebra (CL2), sublaminar hooks applied in compression at the upper thoracic level and sub-laminar bands and clamps in the concavity of the deformity. Statistical analysis was done using t test and Pearson correlation coefficient. Results Between preoperative and last follow-up evaluations a significant reduction of Cobb angle was observed (53.6°vs. 17.2°, p \ 0.001). A significant improvement of the instrumented thoracic kyphosis, TK (19.7°vs. 26.2°, p \ 0.005) was noted, without difference between 3 and 24 months postoperatively. An improvement in lumbar lordosis, LL (43.9°vs. 47.3°, p = 0.009) was also noted but occurred after the third postoperative month. A significant correlation was found between TK correction and improvement of LL (R = 0.382, p = 0.037), without correlation between these reciprocal changes and the amount of coronal correction. Conclusion Results from this study reveal that sagittal reciprocal changes occur after posterior fusion when TK is restored. These changes are visible after 3 months postoperatively, corresponding to a progressive adaptation of patient posture to the surgically induced alignment. These changes are not correlated with coronal plane correction of the deformity. In the setting of AIS, TK restoration is a critical goal and permits favorable postural adaptation. Further studies will include pelvic parameters and clinical scores in order to evaluate the impact of the noted reciprocal changes.

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“…7,8 Recent interest in determining risk factors for postoperative decompensation after STF has led to research attempting to elucidate criteria for predicting the optimal surgical strategy. Factors such as proper selection of the LIV, 1,3,4,24,29,31,37,[41][42][43] the main thoracic to thoracolumbar/lumbar (MT:TL/L) ratio, 25,28,34 thoracic "overcorrection," 5,6,12,13,16,17,19,25,45 and surgical approach have been correlated with risk of postoperative decompensation. Despite guidelines for performing STF, NSTF is still commonly performed, with one study showing only 49% of patients with Lenke 1C curves being treated with an STF.…”

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confidence: 99%

Selective versus nonselective thoracic fusion in Lenke 1C curves: a meta-analysis of baseline characteristics and postoperative outcomes

Boniello¹,

Hasan²,

Sun³

et al. 2015

SPI

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OBJECT Lenke 1C curves are challenging to manage surgically due to the structural thoracic deformity and nonstructural lumbar curve. Selective thoracic fusion (STF) is considered the standard of care because it preserves motion of the lumbar segment, yet nonselective STF (NSTF) remains prevalent. This study aims to identify baseline patient characteristics that drive treatment and to compare postoperative outcomes for both procedures. METHODS Studies that compared baseline and postoperative demographic data, health-related quality of life (HRQL) questionnaires, and radiographic parameters of patients with Lenke 1C curves undergoing STF or NSTF were identified for meta-analysis. The effect measure is expressed as a mean difference (MD) with 95% CI. A positive MD signifies a greater STF value, or a mean increase within the group. RESULTS One prospective and 6 retrospective case-control studies with sample size of 488 patients (344 STF and 144 NSTF) were identified. Baseline age, sex, and HRQLs were equivalent, except for better scores in the STF group for the Scoliosis Appearance Questionnaire (SAQ): Unrelated to Deformity item (3.47 vs 3.88, p = 0.01) and the Spine Research Society questionnaire, Item 22: Pain (4.13 vs 3.92, p = 0.04). Radiographic findings were significantly worse in NSTF, as measured by the thoracolumbar/lumbar (TL/L) Cobb angle (MD: −4.29°, p < 0.01) and TL/L apical vertebral translation (AVT) (MD: −6.08, p < 0.01). Radiographic findings significantly improved in STF, as measured in the main thoracic (MT) Cobb angle (MD: −27.78°, p < 0.01), TL/L Cobb angle (MD: −16.24°, p < 0.01), MT:TL/L Cobb ratio (MD: −0.21, p < 0.01), coronal balance (MD: 0.47, p = 0.02), and thoracic kyphosis (MD: 7.87°, p < 0.01); and in NSTF in proximal thoracic (PT) Cobb angle (24° vs 14.1°, p < 0.01), MT Cobb angle (53.5° vs 20.5°, p < 0.01), and TL/L Cobb angle (41.6° vs 16.6°, p < 0.01). Postoperative TL/L Cobb angle (23.1° vs 16.6°, p < 0.01) was significantly higher in STF; but PT Cobb angle, MT Cobb angle, and MT:TL/L Cobb ratio are equivalent. CONCLUSIONS Patients with larger lumbar compensatory curves displaying a larger degree of coronal translation, as measured by the TL/L AVT, are more likely to undergo an NSTF. Contrary to established guidelines, larger MT curve magnitudes and MT:TL/L Cobb angle ratios have not been found to influence the decision to pursue a selective thoracic fusion. Although overall both STF and NSTF groups are found to have effective postoperative coronal balance, the STF group has only modest improvements in the lumbar curve position as determined by a relatively unchanged TL/L AVT. Furthermore, surgeons may prefer NSTF in patients who may have a worse overall perception of their spinal deformity as measured by HRQL measures of pain and desire for appearance change.

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Predictability of the spontaneous lumbar curve correction after selective thoracic fusion in idiopathic scoliosis

Cited by 54 publications

References 18 publications

Evolution of the curve patterns during brace treatment for adolescent idiopathic scoliosis

Evolution of the curve patterns during brace treatment for adolescent idiopathic scoliosis

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

Selective versus nonselective thoracic fusion in Lenke 1C curves: a meta-analysis of baseline characteristics and postoperative outcomes

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