The Surgical Overcorrection of Lenke Type 1 Deformities with Selective Fusion Segments: What Happens to the Coronal Balance?

Atıcı, Yunus; Erdoğan, Sinan; Akman, Yunus Emre; Mert, Murat; Çarkçı, Engin; Tüzüner, Tolga

doi:10.14245/kjs.2016.13.3.151

Cited by 8 publications

(5 citation statements)

References 22 publications

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“…In one study, overcorrection was defined as the correction more than the major curve's flexibility and it would cause problems in the compensatory curves unless the compensatory is flexible and it corrects totally in bending radiographies, suggesting that lumbar curve magnitude and flexibility have statistically significant impact on postoperative coronal balance [18]. In another study, after overcorrection of Lenke type 1 curve, coronal balance did not show any significant difference between early postoperative period and last follow-up, and it implied that selective fusion with overcorrection in Lenke 1A could be applied when the lumbar curve could be corrected at the preoperative bending radiograph with no preoperative coronal decompensation [19].…”

Section: Discussionmentioning

confidence: 99%

Coronal Imbalance after Selective Posterior Thoracic Fusion in Patients with Lenke 1 and 2 Adolescent Idiopathic Scoliosis

Jiang

Shao

et al. 2018

BioMed Research International

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Coronal decompensation is a common complication in Lenke 1 or 2 AIS patients after selective thoracic fusion (STF). However, the majority who developed immediately postoperative coronal decompensation experienced improvement and the related factors are not fully understood. The aim of this retrospective study was to investigate the prevalence of coronal imbalance in patients with Lenke 1 or 2 AIS and to explore radiological factors associated with spontaneous correction of coronal balance after surgery. Lenke 1 or 2 AIS patients receiving STF in our center from January 2013 to March 2015 were analyzed. Anteroposterior and lateral films were evaluated before surgery, at 1 month's and 2 years' follow-up. Patients were divided into 2 groups according to whether coronal imbalance occurred in the early postoperative period (1 month). Various radiological parameters as well as Scoliosis Research Society-22 were statistically compared between groups. Coronal decompensation was observed in 33 patients preoperatively, in 48 patients immediately postoperatively, and in 2 patients at final follow-up. Lowermost instrumented vertebra (LIV) disc angle (0.9° vs. 6.7°, p=0.019) and LIV- C7 plumb line and central sacral vertical line (CSVL) (-3.4mm vs. -13.7mm, p=0.020) increased in the final follow-up in the imbalanced group of type A modifier. The magnitude of lumbar curve was greater in the imbalanced group of type B or C modifier in the early postoperative period (19.5° vs. 12.6°, p=0.006; 25.5° vs. 13.7°, p<0.01), and this difference disappeared in the final follow-up. No differences in SRS-22 outcome scores were noted between groups in different time. Coronal imbalance was frequently detected immediately after STF in Lenke 1 or 2 AIS patients, with type C modifier slightly higher than A or B. Distal adding-on may help compensate for coronal imbalance in patients with type A modifier, while spontaneous correction of lumbar curve attributes to the improvement of coronal imbalance in patients with type B or C modifier.

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Section: Discussionmentioning

confidence: 99%

Coronal Imbalance after Selective Posterior Thoracic Fusion in Patients with Lenke 1 and 2 Adolescent Idiopathic Scoliosis

Jiang

Shao

et al. 2018

BioMed Research International

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“…Previous studies have reported that postoperative CIB is associated with back pain, unsatisfactory appearance, poorer HRQoL, and even revision surgery [ 18 , 19 , 20 ]. The occurrence of postoperation CIB is multifactorial, with potentially relevant factors including improper selection of fusion segment, over-correction or under-correction, pelvis tilt, and lower limbs discrepancy [ 14 , 21 ], resulting in the compensation mechanism being complex and unpredictable.…”

Section: Discussionmentioning

confidence: 99%

Apical Vertebras Distribution Modifier for Coronal Balance Classification in Adult Idiopathic Scoliosis

Pan

Hai

Lenke

et al. 2023

JPM

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Background: We aimed to propose the apical vertebras distribution modifier to supplement the coronal balance (CB) classification for adult idiopathic scoliosis (AdIS). An algorithm to predict postoperative coronal compensation and avoid postoperative coronal imbalance (CIB) was proposed. Methods: Patients were categorized into CB and CIB groups according to the preoperative coronal balance distance (CBD). The apical vertebras distribution modifier was defined as negative (−) if the centers of the apical vertebras (CoAVs) were on either side of the central sacral vertical line (CSVL) and positive (+) if the CoAVs were on the same side of the CSVL. Results: A total of 80 AdIS patients, with an average age of 25.97 ± 9.20 years, who underwent posterior spinal fusion (PSF) were prospectively recruited. The mean Cobb angle of the main curve was 107.25 ± 21.11 degrees at preoperation. The mean follow-up time was 3.76 ± 1.38 (2–8) years. At postoperation and follow-up, CIB occurred in 7 (70%) and 4 (40%) CB− patients, 23 (50%) and 13 (28.26%) CB+ patients, 6 (60%) and 6 (60%) CIB− patients, and 9 (64.29%) and 10 (71.43%) CIB+ patients. Health-related quality of life (HRQoL) was significantly better in the CIB− group compared with that of the CIB+ group in the dimension of back pain. To avoid postoperative CIB, the correction rate of the main curve (CRMC) should match the compensatory curve for CB−/+ patients; the CRMC should be greater than the compensatory curve for CIB− patients; and the CRMC should be less than the compensatory curve for CIB+ patients, and the inclination of the LIV needs to be reduced. Conclusions: CB+ patients have the least postoperative CIB rate and the best coronal compensatory ability. CIB+ patients are at a high risk of postoperative CIB and have the poorest coronal compensatory capacity in the event of postoperative CIB. The proposed surgical algorithm facilitates the handling of each type of coronal alignment.

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“…Excessive correction of the MT curve is a momentous cause of PSI. As the scoliosis correction rate has amplified in recent years, surgeons must remember that the MT curve should not be overcorrected [14]. In addition, the postoperative behavior of the lumbar curve, including the distal adding-on, affects the postoperative shoulder balance.…”

Section: Discussionmentioning

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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The Surgical Overcorrection of Lenke Type 1 Deformities with Selective Fusion Segments: What Happens to the Coronal Balance?

Cited by 8 publications

References 22 publications

Coronal Imbalance after Selective Posterior Thoracic Fusion in Patients with Lenke 1 and 2 Adolescent Idiopathic Scoliosis

Coronal Imbalance after Selective Posterior Thoracic Fusion in Patients with Lenke 1 and 2 Adolescent Idiopathic Scoliosis

Apical Vertebras Distribution Modifier for Coronal Balance Classification in Adult Idiopathic Scoliosis

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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