Sagittal Plane Analysis in Idiopathic Scoliosis Patients Treated with Cotrel-Dubousset Instrumentation

Bridwell, Keith H.; Betz, Randall; Capelli, A; Huss, Gail K.; Harvey, Charles J.

doi:10.1097/00007632-199007000-00006

Cited by 85 publications

(43 citation statements)

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“…Individuals with idiopathic scoliosis typically also show an altered sagittal profile of the vertebral column with a flat lower back and hypokyphosis or even lordosis in the thoracic region (Bridwell et al, 1990). Our data and the sagittal wedging angles estimated by Latimer and Ward (1993), however, imply a slightly greater lordosis in the lower lumbar region of KNM-WT 15000 and a compensatorily increased kyphotic wedging at the thoracolumbar transition compared to the modal condition in modern humans.…”

Section: Discussionsupporting

confidence: 38%

Revisiting scoliosis in the KNM-WT 15000 Homo erectus skeleton

Schiess¹,

Boeni²,

Rühli³

et al. 2014

Journal of Human Evolution

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Owing to its completeness, the 1.5 million year old Nariokotome boy skeleton KNM-WT 15000 is central for understanding skeletal biology of Homo erectus. Nevertheless, since Latimer and Ohman (2001, Axial dysplasia in Homo erectus. J Hum Evol 40:A12) reported on asymmetries and distortions of Nariokotome boy's axial skeleton suggesting adolescent idiopathic scoliosis, possibly associated with congenital skeletal dysplasia, it is questionable whether it still can be used as reference for Homo erectus. Recently, however, the presence of skeletal dysplasia has been refuted. Here, we present a morphologic and morphometric reanalysis of the assertion of idiopathic scoliosis. We demonstrate that unarticulated vertebral columns of non-scoliotic and scoliotic individuals can be distinguished based on the lateral deviation of the spinous process, lateral and sagittal wedging, vertebral body torsion, pedicle thickness asymmetry and asymmetry of the superior and inferior articular facet area. A principal component analysis of the overall asymmetry of all seven vertebral shape variables groups KNM-WT 15000 within non-scoliotic modern humans. An anomaly of vertebrae T1-T2 is compatible with a short left convex curve at the uppermost thoracic region, possibly due to injury or local growth dysbalance. Asymmetries of the facet joints L3-L5 suggest a local right convex curve in the lower lumbar region that probably resulted from juvenile traumatic disc herniation. This pattern is incompatible with adolescent idiopathic scoliosis or other types of scoliosis, including congenital, neuromuscular or syndromic scoliosis. It is, however, consistent with a recent reanalysis of the rib cage that did not reveal any asymmetry. Except for these possibly trauma-related anomalies, the Nariokotome boy fossil therefore seems to belong to a normal Homo erectus youth without evidence for adolescent idiopathic scoliosis or other severe pathologies of the axial skeleton. AbstractOwing to its completeness, the 1.5 million year old Nariokotome boy skeleton KNM-WT 15000 is central for understanding skeletal biology of Homo erectus. Nevertheless, since Latimer and Ohman (2001, Axial dysplasia in Homo erectus. J Hum Evol 40:A12) reported on asymmetries and distortions of Nariokotome boy's axial skeleton suggesting adolescent idiopathic scoliosis, possibly associated with congenital skeletal dysplasia, it is questionable whether it still can be used as reference for Homo erectus. Recently, however, the presence of skeletal dysplasia has been refuted. Here, we present a morphologic and morphometric reanalysis of the assertion of idiopathic scoliosis. We demonstrate that unarticulated vertebral columns of non-scoliotic and scoliotic individuals can be distinguished based on the lateral deviation of the spinous process, lateral and sagittal wedging, vertebral body torsion, pedicle thickness asymmetry and asymmetry of the superior and inferior articular facet area. A principal component analysis of the overall asymmetry of all seven vertebral shap...

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Section: Discussionsupporting

confidence: 38%

Revisiting scoliosis in the KNM-WT 15000 Homo erectus skeleton

Schiess¹,

Boeni²,

Rühli³

et al. 2014

Journal of Human Evolution

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“…The first cervical vertebra not above the second sacral segment on the standing lateral film of the spine 2. Kyphosis or lordosis exaggerated or diminished beyond the accepted range of the sagittal vertebral contour [4,5,28,29,47].…”

Section: Coronal Imbalancementioning

confidence: 99%

“…As a working hypothesis, we can refer to Bridwell, Jackson, and Schultz for basic statements about the normal spine, erect over a neutralized pelvis [5,28,47]. Ferguson mentioned the importance of centering the fusion mass over the sacrum as early as in 1930 [18].…”

Section: The Sagittal Planementioning

confidence: 99%

An algorithm for selection of instrumentation levels in scoliosis

Margulies¹,

Floman

Robin

et al. 1998

European Spine Journal

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IntroductionAppropriate levels for instrumentation and fusion in idiopathic scoliosis have been a matter of debate among surgeons since the introduction of operative management of this deformity some 80 years ago [7, 18, 23-25, 39, 45]. It is important to fuse the smallest possible number of vertebrae to maintain maximum residual mobility, but end with a well-balanced spine [36,54]. The longer the instrumentation, the greater the chance to gain control over the various curves and end up with a balanced spine. Shorter instrumentations may yield a well-balanced, mobile spine, with reduction of the scoliotic curves both in the instrumented and non-instrumented portions of the spine. Levels for fusion with Harrington instrumentation were defined according to King's classification [31, 32]. This approach does not emphasize the sagittal profile of the spine. Loss of lumbar lordosis with sagittal imbalance was quite common and known as the "flat back" syndrome [1,8,17, 34,35,52]. Subsequently, the sagittal profile was recognized to be important by Winter, Dickson and Armstrong [2,[11][12][13][56][57][58].With increased use of CD instrumentation and similar segmental systems, postoperative frontal imbalance has been more frequently noted than that reported with Harrington instrumentation. The newer posterior segmental systems facilitate better operative correction of scoliosis than Harrington instrumentation, and the option of anterior release enables even greater correction to be achieved.Abstract Appropriate levels for instrumentation and fusion in scoliosis have been a matter of debate among surgeons since the introduction of operative management of this deformity. We set out to examine the hypothesis that the amount of correction achieved in all planes during surgical instrumentation of a curve should be less than, or comparable to, the degree of correction attainable at any non-instrumented adjacent curve. An algorithm was designed to facilitate preoperative planning and intraoperative performance of spinal fusion procedures in the management of scoliosis. To test the validity of the hypothesis and the proposed algorithm, measurements were taken from the preoperative radiographs of 200 patients. The dimensions of the curves were obtained from an initial set of four X-ray films: (1) standing anteroposterior film of the whole spine, (2) standing lateral film of the whole spine, (3) two properly performed side-bending films including each curve of the spine. With this data, a plan was designed using the algorithm. The results of this plan were compared with the actual results of the surgery, which were revealed only at this stage. All patients in whom actual instrumentation levels fell within those predicted by the proposed algorithm had no imbalance at follow-up. All patients whose actual instrumentation levels were short of those recommended by the algorithm showed obvious imbalance on final postoperative standing radiograph.

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“…In particular, the Cotrel-Dubousset technique restores thoracic kyphosis for patients with hypokyphotic spines and preserves or restores normal lumbar lordosis in a considerable percentage of patients [10][11][12]. Studies evaluating the effects of scoliosis surgery on cervical spine sagittal alignment are scarce and it is possible that scoliotic patients treated with surgery have a greater incidence of cervicodorsal pain when compared with normal subjects [13].…”

Section: Introductionmentioning

confidence: 99%

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

et al. 2011

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The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior-posterior and lateral radiographs of the entire spine were reviewed to assess the changes of cervical sagittal alignment. Thirty-two patients (3 boys, 29 girls) met the inclusion criteria for the study. The average pre-operative cervical sagittal alignment (CSA) was 4.0°± 12.3°(range -30°to 40°) of lordosis. Postoperatively, the average CSA was 1.7°± 11.4°(range -24°to 30°). After surgery, it was less than 20°in 27 patients (84.4%) and between 20°and 40°in 5 patients (15.6%). The results of the present study suggest that even if rod precontouring is performed and postoperative thoracic sagittal alignment is restored, improved or remains unchanged after significant correction of the deformity on the frontal plane, the inherent rigidity of the cervical spine limits changes in the CSA as the cervical spine becomes rigid over time.

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Sagittal Plane Analysis in Idiopathic Scoliosis Patients Treated with Cotrel-Dubousset Instrumentation

Cited by 85 publications

References 0 publications

Revisiting scoliosis in the KNM-WT 15000 Homo erectus skeleton

Revisiting scoliosis in the KNM-WT 15000 Homo erectus skeleton

An algorithm for selection of instrumentation levels in scoliosis

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

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