The Lumbosacral Takeoff Angle Can Be Used to Predict the Postoperative Lumbar Cobb Angle Following Selective Thoracic Fusion in Patients with Adolescent Idiopathic Scoliosis

Bachmann, Keith R.; Lu, Edwin; Novicoff, Wendy M.; Newton, Peter O.; Abel, Mark F.

doi:10.2106/jbjs.19.00287

Cited by 13 publications

(19 citation statements)

References 9 publications

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“…In recent years, significant progress has been made in the identification of radiographic parameters to aid surgeons in the decision between STF and N-STF. Bachmann et al, in a study analyzing 220 patients captured from a prospective longitudinal database, observed the lumbosacral takeoff angle, i.e., the angle between the center-sacral vertical line and a line through the centra of S1, L5, and L4 could be used to predict the residual lumbar Cobb angle in patients undergoing STFs [ 13 ]. Koller et al, in an interesting multicentre prospective database study recruiting 410 AIS patients, established an accurate prediction model for postoperative spontaneous lumbar curve correction, in patients undergoing selective STF [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although in recent years, several studies [9,[12][13][14] have attempted to identify preoperative radiologic factors able to predict the successful outcome of STFs, none of the previous studies, to the authors' knowledge, has focused on the body's image perception in adolescents undergoing posterior STF, compared with non-selective fusion (N-STF).…”

Section: Introductionmentioning

confidence: 99%

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Subjective perception of spinal deformity after selective versus non-selective fusion of Lenke 1C curves

Bizzoca

Piazzolla²,

Solarino

et al. 2022

Spine Deform

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Purpose To assess the self-image perception and the Quality-of-Life (QoL) in female adolescents, with Lenke 1C scoliosis curves, treated with selective versus non-selective posterior spinal instrumentation and fusion (PSF). Methods Patients undergoing PSF for idiopathic adolescent scoliosis (AIS) were recruited and divided into two groups: patients managed with selective thoracic fusion (STF) were included in Group A, whereas patients treated with non-selective fusion (N-STF) in Group B. Each patient completed the Italian version of the Scoliosis Research Society-22R questionnaire (SRS-22R), the Quality-of-Life Profile for Spinal Deformities questionnaire (QLPSD) and the Spinal Appearance Questionnaire (SAQ), before surgery and at 24-month follow-up. Results One hundred and fifty seven female patients (mean age 16.38) were included in this study. 80 patients underwent STF, while 77 patients received N-STF. At 24-month follow-up, patients managed with N-STF showed better SRS-22R self-image mean score (p = .012), SRS-22R satisfaction mean score (p = .033), QLPSD body image mean score (p = .005), but worse SRS-22 function mean score (p = .006) and QLPSD back flexibility mean score (p = .007), compared with patients who underwent STF. In terms of self-image perception, patients undergoing STF showed significantly worse SAQ total mean score (p = .002), SAQ appearance mean score (p = .001) and SAQ expectation (p = .001). We found a significant correlation between SAQ appearance mean score and SRS-22R self-image (R = − 0.721), SRS-22 mental health (R = − 0.8), QLPSD psychosocial functioning (R = 0.7) and QLPSD back flexibility (R = 0.8). Conclusion Although the STF of Lenke 1C curves provides better functional outcomes, in the present study, female patients receiving STF revealed a worse perceived body image, compared with patients treated with N-STF, at 24-month follow-up. Particular attention should be addressed to the preoperative patient’s mental health and body image perception, when choosing between STF and N-STF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Subjective perception of spinal deformity after selective versus non-selective fusion of Lenke 1C curves

Bizzoca

Piazzolla²,

Solarino

et al. 2022

Spine Deform

View full text Add to dashboard Cite

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“…Two-dimensional classification systems of the scoliotic spine are developed to assist with surgical planning [2,10,11]. Yet, variations in the surgical outcomes exist partially due to the fact that the 3D shapes of the scoliotic spines are not incorporated in these classification systems [12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional classification of the Lenke 1 adolescent idiopathic scoliosis using coronal and lateral spinal radiographs

Pasha

Ho-Fung

Eker

et al. 2020

BMC Musculoskelet Disord

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Background Classification of the spinal deformity in adolescent idiopathic scoliosis (AIS) remains two-dimensional (2D) as the spinal radiographs remain the mainstay in clinical evaluation of the disease. 3D classification systems are proposed, however are time consuming. We here aim to evaluate the clinical application of a 3D classification system by the use of only posterior-anterior and lateral radiographs in Lenke 1 adolescent idiopathic scoliosis (AIS). Methods Forty Lenke 1 AIS were classified by five observers following a three-step flowchart, developed based on our previous 3D classification system. This 3D classification characterizes the curve in the frontal and sagittal views and infers the third dimension with rules based on prior data to determine the 3D subtypes of the curve. Repeated rating was performed for 20 randomly selected patients in the same cohort. In addition to the classification by the raters, the 3D model of the spines were generated to determine the actual curve subtype based on the algorithm that was originally used to develop the 3D classification system. The interobserver and intraobserver reliability and the classification accuracy were determined for both 3D and axial classifications of the cohort. Results The interobserver reliability was moderate to strong with a kappa value between 0.61–0.89 for 3D and axial classifications. Comparing the mathematical classification and the raters’ classification, the classification accuracy among all raters ranged between 56 and 89%. Conclusion We evaluated the reliability of a previously developed 3D classification system for Lenke 1 AIS patients when only two-view spinal radiographs are available. Radiologists and orthopedic surgeons were able to identify the 3D subtypes of Lenke 1 AIS from the patients’ radiographs with moderate to strong reliability. The new 3D classification has the potential to identify the subtypes of the Lenke 1 AIS without a need for quantitative 3D image post-processing.

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“…Bachmann et al [ 9 ] validated that STF mainly produced changes in the upper half of the lumbar curve, leaving the lower half and the lumbosacral takeoff angle with little change. Mason et al [ 10 ] proposed that most lumbar coronal corrections could occur in the proximal region above the lumbar apex post STF.…”

Section: Introductionmentioning

confidence: 99%

Characteristics analysis of segmental and regional lumbar spontaneous compensation post thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis

Chen

Zhai

Zhou

et al. 2021

BMC Musculoskelet Disord

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Objective To explore the characteristics of compensation of unfused lumbar region post thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis. Background Preserving lumbar mobility in the compensation is significant in controlling pain and maintaining its functions. The spontaneous correction of the distal unfused lumbar curve after STF has been widely reported, but previous study has not concentrated on the characteristics of compensation of unfused lumbar region post thoracic fusion. Method A total of 51 Lenke 1 and2 AIS patients were included, whose lowest instrumented vertebrae was L1 from January 2013 to December 2019. For further analysis, demographic data and coronal radiographic films were collected before surgery, at immediate erect postoperatively and final follow-up. The wedge angles of each unfused distal lumbar segments were measured, and the variations in each disc segment were calculated at the immediate postoperative review and final follow-up. Meanwhile, the unfused lumbar curve was divided into upper and lower parts, and we calculated their curve angles and compensations. Results The current study enrolled 41 females (80.4%) and 10 males (19.6%). Thirty-six patients were Lenke type 1, while 15 patients were Lenke type 2. The average main thoracic Cobb angle and thoracolumbar/lumbar Cobb angle were 44.1 ± 7.7°and 24.1 ± 9.3°, preoperatively. At the final follow-up, the disc wedge angle variation of L1/2, L2/3, L3/4, L4/5 and L5/S1 was 3.84 ± 5.96°, 3.09 ± 4.54°, 2.30 ± 4.53°, − 0.12 ± 3.89° and − 1.36 ± 2.80°, respectively. The compensation of upper and lower coronal lumbar curves at final follow-up were 9.22 ± 10.39° and − 1.49 ± 5.14°, respectively. Conclusion When choosing L1 as the lowest instrumented vertebrae, the distal unfused lumbar segments’ compensation showed a decreasing trend from the proximal end to the distal end. The adjacent L1/2 and L2/3 discs significantly contributed to this compensation.

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The Lumbosacral Takeoff Angle Can Be Used to Predict the Postoperative Lumbar Cobb Angle Following Selective Thoracic Fusion in Patients with Adolescent Idiopathic Scoliosis

Cited by 13 publications

References 9 publications

Subjective perception of spinal deformity after selective versus non-selective fusion of Lenke 1C curves

Subjective perception of spinal deformity after selective versus non-selective fusion of Lenke 1C curves

Three-dimensional classification of the Lenke 1 adolescent idiopathic scoliosis using coronal and lateral spinal radiographs

Characteristics analysis of segmental and regional lumbar spontaneous compensation post thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis

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