The association of lumbar curve magnitude and spinal range of motion in adolescent idiopathic scoliosis: a cross-sectional study

Abstract

BackgroundSpinal deformities affect the overall alignment of the spine and thus the vectors of loading on the lumbar region and intervertebral discs. Due to wedging of the disc or vertebrae of unbalanced spinal segments, alignment change may affect the range of motion (ROM) of individual spinal segments or the global spine. This is particularly important in adolescent idiopathic scoliosis (AIS) patients who may suffer from early degeneration, back stiffness and pain. Hence, this study aimed to determine the correlation between spine range of motion (ROM) and adolescent idiopathic scoliosis (AIS) curve magnitude.MethodsConsecutive recruitment of all AIS patients with Lenke 5 (thoracolumbar/lumbar) curves within one month was performed with ROM assessments in the coronal, sagittal and axial planes using the change in C7-S1 distance on standing upright, active flexion and extension positions, change in finger-floor distance on forward bending position and lateral bending, lateral bending angles, modified Schober’s test, and trunk rotation in seating position. Patients were further stratified into two groups based on their lumbar spine curve magnitude: Group A with curves of 10 to 39 degrees and Group B with 40 degrees or greater. Univariate and multivariate analyses were conducted, with lumbar curve magnitude severity being the dependent variable.ResultsIn total, 58 patients (n = 12 males, n = 46 females; mean age: 15.7 years) were recruited. The mean curve magnitudes were 25 ± 6.5 degrees in Group A and 48 ± 10.6 degrees in Group B. Mean axial rotation (Group A: 90 ± 21.7 degree; Group B: 76 ± 19.6 degrees; p = 0.038) and lateral bending ROM (Group A: 67 ± 13.4 degrees; Group B: 58 ± 14.3 degrees; p = 0.045) decreased in more severe curves. These two parameters continued to remain significant irrespective of the curve severity cut-off values.ConclusionsThis is the first study to determine associations between spinal ROM parameters with the lumbar curve magnitude in AIS patients. We found that the coronal curve severity is associated with reduced axial and coronal ROM. This is a platform for future studies assessing lumbar spine biomechanics in AIS and to determine the effects of altered spine motion in this context and its implication in patient management and outcomes.

APSS-ASJ Best Clinical Research Award: Predictability of Curve Progression in Adolescent Idiopathic Scoliosis Using the Distal Radius and Ulna Classification

“…Hence, the results of this study do not indicate the duration of brace wear required. In addition, curve flexibility has been shown to greatly influence the outcomes of bracing and surgery [ 32 33 34 35 ]. This aspect of bracing, as well as the varied responses of different curve patterns, is beyond the intent of this study and should be addressed in future studies.…”

Patterns of coronal and sagittal deformities in adolescent idiopathic scoliosis

“…As AIS is a three-dimensional deformity, management should not be focused only on the coronal plane. The coronal and sagittal plane deformities are coupled and thus, variations in the coronal plane may translate into sagittal plane changes [ 3 – 5 ]. Mac-Thiong et al [ 6 ] evaluated the sagittal alignment of 160 patients with AIS and found less thoracic kyphosis in thoracic major curves compared to lumbar curves, and lumbar curve patients tend to have larger lumbar lordosis.…”

Proper positioning of mice for Cobb angle radiographic measurements

“…Scoliosis is not necessarily a deadly disease, but it affects the patients’ cosmesis, mobility, pain and quality of life [ 21 , 22 ]. The diagnosis and management decision of scoliosis relies on the Cobb angle measurement and thus these measurements must be accurate and consistent.…”