Spinal fusion on adolescent idiopathic scoliosis patients with the level of L4 or lower can increase lumbar disc degeneration with sagittal imbalance 35 years after surgery

Akazawa, Tsutomu; Kotani, Toshiaki; Sakuma, Takashi; Minami, Shohei; Orita, Sumihisa; Fujimoto, Kazuki; Takaso, Masashi; Inoue, Gen; Miyagi, Masayuki; Aoki, Yasuchika; Niki, Hisateru; Torii, Yoshiaki; Morioka, Shigeta; Ohtori, Seiji; Takahashi, Kazuhisa

doi:10.22603/ssrr.1.2016-0017

Cited by 31 publications

(35 citation statements)

References 22 publications

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“…Disc degeneration after AIS spinal fusion was reported to be affected by various factors such as the number of mobile intervertebral discs, coronal X-ray parameters, and sagittal X-ray parameters 1,2,5,6,8) . The fewer non-fused discs, the more likely DD was to occur, and LIV fusing below L4 was generally not recommended 2,8) . The coronal parameters lumbar curve size and interbody tilt have been associated with DD.…”

Section: Discussionmentioning

confidence: 99%

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Spinal Alignments of Residual Lumbar Curve Affect Disc Degeneration after Spinal Fusion in Patients with Adolescent Idiopathic Scoliosis: Follow-up after 5 or More Years

Akazawa

Umehara

Iinuma

et al. 2020

Spine Surg Relat Res

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Introduction: Despite preserving lumbar disc mobility, spinal sagittal, and/or coronal alignment might ultimately impede surgical success. The purpose of this study was to elucidate the effects of spinal alignment on lumbar disc degeneration after 5 or more years in adolescent idiopathic scoliosis (AIS) patients who underwent spinal fusion.Methods: Subjects were 49 AIS patients who underwent posterior spinal fusion without lumbar curve fusion. The inclusion criteria were the following: 1) Lenke type 1A, 1B, 2A or 2B, 2) age 10 to 19 years at the time of operation, and 3) minimum 5-year follow-up. The exclusion criteria were the following: 1) diagnosed as other than AIS, 2) history of lumbar disc herniation and spondylolysis, 3) subsequent surgery, and 4) history of surgery before AIS surgery. Nineteen patients agreed to participate in this research. X-rays, lumbar MRI, and questionnaires were evaluated. Disc degeneration in nonfused segments was defined as Pfirrmann grade 3 or higher. Patients with disc degenerations at the final observation (DD[+] group) were compared to those without disc degenerations (DD[−] group).Results: There were no significant differences in the preoperative or postoperative 1-week X-ray parameters between both groups. The lumbar curve was significantly larger in the DD[+] group compared with the DD[−] group at the final observation (DD[+]: 16.8 degrees, DD[−]: 10.4 degrees, p = 0.035). The sagittal vertical axis (SVA) was significantly larger in the DD[+] group compared with the DD[−] group at the final observation (DD[+]: −4.4 mm, DD[−]: −34.3 mm, p = 0.006). SRS-22 function, self-image, and satisfaction scores were lower in the DD [+] group compared with the DD[−] group at the final observation.Conclusions: The patients with DD had significantly larger lumbar curve and SVA with lower SRS-22 function, selfimage, and satisfaction scores at the final observation. Even though the non-fused segments were preserved, spinal alignments of non-fused lumbar curve affect the DDs.

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Section: Discussionmentioning

confidence: 99%

“…Since spinal fusion in adolescent idiopathic scoliosis (AIS) is often performed during adolescence, it is important to consider long-term outcomes. In spinal fusion, preserving lumbar spine mobility is believed to be advantageous in controlling pain and maintaining functionality 1,2) .…”

Section: Introductionmentioning

confidence: 99%

Spinal Alignments of Residual Lumbar Curve Affect Disc Degeneration after Spinal Fusion in Patients with Adolescent Idiopathic Scoliosis: Follow-up after 5 or More Years

Akazawa

Umehara

Iinuma

et al. 2020

Spine Surg Relat Res

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“…The generally accepted goals of surgery for adolescent idiopathic scoliosis are: avoiding further progression through solid fusion and correction of the deformity into a balanced configuration to restore postural balance [1,2]. There is increasing evidence that successful restoration of a harmonious, balanced spine may have a protective effect on the unfused discs, as well as that a critical thoracic kyphosis is required to prevent sagittal plane deterioration and adding on, as well as proximal junctional kyphosis [3][4][5][6]. A common problem in posterior thoracic fusion for primary thoracic adolescent idiopathic scoliosis, however, is the flattening effect on the thoracic sagittal profile when derotation and coronal correction are performed [7,8].…”

Section: Introductionmentioning

confidence: 99%

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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“…Since spinal fusions for adolescent idiopathic scoliosis (AIS) are performed on adolescent patients, its appearance is one of the crucial concerns, along with back pain, function, and quality of life [1-3]. Although shoulder imbalance is a critical concern after spinal fusions, the prevalence of postoperative shoulder imbalance (PSI) is reportedly as high as 25% [4].…”

Section: Introductionmentioning

confidence: 99%

Hooks at the Upper Instrumented Vertebra Can Adjust Postoperative Shoulder Balance in Patients with Adolescent Idiopathic Scoliosis: 5 Years or More of Follow-up

et al. 2019

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This study aims to investigate postoperative shoulder imbalance (PSI) ≥5 years postoperatively in patients who underwent posterior spinal fusion using hooks at the upper instrumented vertebra (UIV) for Lenke type 1 adolescent idiopathic scoliosis (AIS). Overview of Literature: Studies have reported PSI due to excessive correction of the main thoracic curve. Methods: We examined 56 patients with AIS who underwent a posterior spinal fusion with hooks at the UIV from 2004 to 2010. Of these, we enrolled 14 patients who underwent surgery, at least, 5 years ago. X-rays and Scoliosis Research Society-22 (SRS-22) questionnaire were administered. To evaluate the shoulder balance, T1 vertebral tilt angle (T1 tilt), clavicle angle, and radiographic shoulder height (RSH) were measured. PSI was considered as the absolute value of the postoperative RSH being ≥20 mm. Based on radiographs obtained immediately postoperatively, we divided patients into two groups as follows: the balanced group (absolute value of RSH <20 mm) and imbalanced group (absolute value of RSH ≥20 mm). Results: The frequency of PSI was 28.6% immediately postoperatively, 0% 2 years postoperatively, and 7.1% at the last follow-up. In the balanced group, PSI did not occur even at 2 years postoperatively or at the last follow-up. In the imbalanced group, PSI was improved in all patients 2 years postoperatively and all patients, except one patient, at the last follow-up. No significant differences were noted in the frequency of distal adding-on at 2 years postoperatively or the last follow-up between the balanced group and the imbalanced group. We observed moderate negative correlations between the absolute value of T1 tilt and the SRS-22 pain and satisfaction at the last follow-up. Conclusions: Hooks at the UIV could adjust the shoulder balance to avoid long-term PSI in patients with AIS.

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Spinal fusion on adolescent idiopathic scoliosis patients with the level of L4 or lower can increase lumbar disc degeneration with sagittal imbalance 35 years after surgery

Cited by 31 publications

References 22 publications

Spinal Alignments of Residual Lumbar Curve Affect Disc Degeneration after Spinal Fusion in Patients with Adolescent Idiopathic Scoliosis: Follow-up after 5 or More Years

Spinal Alignments of Residual Lumbar Curve Affect Disc Degeneration after Spinal Fusion in Patients with Adolescent Idiopathic Scoliosis: Follow-up after 5 or More Years

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

Hooks at the Upper Instrumented Vertebra Can Adjust Postoperative Shoulder Balance in Patients with Adolescent Idiopathic Scoliosis: 5 Years or More of Follow-up

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