Changes in Lumbar Lordosis after Further Spinal Fusion of Thoracic Spine and its Relationship to the Pelvic Incidence.
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Published:
May 11, 2016
Keywords:
Thoracic spine, arthrodesis, pelvic incidence, adolescent idiopathic scoliosis, pedicular screws.
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Abstract
Objective:To evaluate the sagittal profile of surgically treated Lenke type 1 patients and determine which variables affect postoperative lumbar lordosis.Methods: Twenty consecutive patients (average age 14 years) diagnosed with AIS and Lenke type 1 curves that have undergone a selective thoracic PSIF with pedicular screws were retrospectively evaluated. Cervical lordosis, thoracic kyphosis, proximal junctional kyphosis, lumbar lordosis, pelvic incidence and global sagittal balance were measured in preoperative, immediate postoperative and 2-year postoperative standing lateral radiographs. Changes in postoperative lumbar lordosis were correlated with changes in thoracic kyphosis and pelvic incidence. Analysis of variance was used to compare preoperative and postoperative radiographic measures, and Pearson coefficients for the correlation analysis.Results: There was a significant decreased in thoracic kyphosis (24.2° to 14.8° (p<0.0001)) and lumbar lordosis (-60.3° to -39.8° (p<0.00001)) between preoperative and immediate postoperative radiographs, but both parameters showed an increased in 2-year postoperative radiographs (thoracic kyphosis to 18.7° (p=0.021) and lumbar lordosis to -52.4° (p=0.0036)). We also found a significant increased in proximal junctional kyphosis (5.1° to 12.4° (p<0.0001)) and cervical lordosis (-4.2° to -14.8° (p=0.025)) between preoperative and 2-year postoperative radiographs. The only significant postoperative correlation found was between lumbar lordosis and pelvic incidence (r=0.61) at 2-year follow-up radiographs.Conclusion: PSIF with pedicle screws of Lenke type 1 deformities reduces thoracic kyphosis and lumbar lordosis, and increases cervical lordosis and proximal junctional kyphosis. Uninstrumented lumbar lordosis increase at 2-year follow-up and is strongly related to patient pelvic incidence.
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Puigdevall, M., Bosio, S., Halliburton, C., Hokama, J., & Maenza, R. (2016). Changes in Lumbar Lordosis after Further Spinal Fusion of Thoracic Spine and its Relationship to the Pelvic Incidence. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(2), 122-127. https://doi.org/10.15417/421
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Clinical Research
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References
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3. Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, Hyman JE, Roye DP Jr. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976). 2007 Feb 15;32(4):448-52.
4. Newton PO, Yaszay B, Upasani VV, Pawelek JB, Bastrom TP, Lenke LG, Lowe T, Crawford A, Betz R, Lonner B; Harms Study Group. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2010 Jun 15;35(14):1365-70.
5. Khakinahad M, Ameri E, Ghandhari H, Tari H. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Acta Med Iran. 2012;50(7):477-81.
6. Mac-Thiong JM, Labelle H, Berthonnaud E, Betz RR, Roussouly P. Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J. 2007 Feb;16(2):227-34.
7. Mac-Thiong JM, Labelle H, Charlebois M, Huot MP, de Guise JA. Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type. Spine (Phila Pa 1976). 2003 Jul 1;28(13):1404-9.
8. Tanguay F, Mac-Thiong JM, de Guise JA, Labelle H. Relation between the sagittal pelvic and lumbar spine geometries following surgical correction of adolescent idiopathic scoliosis. Eur Spine J. 2007 Apr;16(4):531-6.
9. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001 Aug;83-A(8):1169-81.
10. Sucato DJ, Agrawal S, O'Brien MF, Lowe TG, Richards SB, Lenke L. Restoration of thoracic kyphosis after operative treatment of adolescent idiopathic scoliosis: a multicenter comparison of three surgical approaches. Spine (Phila Pa 1976). 2008 Nov 15;33(24):2630-6.
11. Jaquith BP, Chase A, Flinn P, Sawyer JR, Warner WC, Freeman BL, Kelly DM. Screws versus hooks: implant cost and deformity correction in adolescent idiopathic scoliosis. J Child Orthop. 2012 Jun;6(2):137-43.
12. Betz RR, Harms J, Clements DH 3rd, Lenke LG, Lowe TG, Shufflebarger HL, Jeszenszky D, Beele B. Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idiopathic scoliosis. Spine (Phila Pa 1976). 1999 Feb 1;24(3):225-39.
13. Rhee JM, Bridwell KH, Won DS, Lenke LG, Chotigavanichaya C, Hanson DS. Sagittal plane analysis of adolescent idiopathic scoliosis: the effect of anterior versus posterior instrumentation. Spine (Phila Pa 1976). 2002 Nov 1;27(21):2350-6.
14. Kim YJ, Lenke LG, Bridwell KH, Kim J, Cho SK, Cheh G, Yoon J. Proximal junctional kyphosis in adolescent idiopathic scoliosjjjjjkkis after 3 different types of posterior segmental spinal instrumentation and fusions: incidence and risk factor analysis of 410 cases. Spine (Phila Pa 1976). 2007 Nov 15;32(24):2731-8.
15. Legarreta CA, Barrios C, Rositto GE, Reviriego JM, Maruenda JI, Escalada MN, Piza-Vallespir G, Burgos J, Hevia E. Cervical and thoracic sagittal misalignment after surgery for adolescent idiopathic scoliosis: a comparative study of all pedicle screws versus hybrid instrumentation. Spine (Phila Pa 1976). 2014 Jul 15;39(16):1330-7.
2. Kim YJ, Lenke LG, Kim J, Bridwell KH, Cho SK, Cheh G, Sides B. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2006 Feb 1;31(3):291-8.
3. Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, Hyman JE, Roye DP Jr. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976). 2007 Feb 15;32(4):448-52.
4. Newton PO, Yaszay B, Upasani VV, Pawelek JB, Bastrom TP, Lenke LG, Lowe T, Crawford A, Betz R, Lonner B; Harms Study Group. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2010 Jun 15;35(14):1365-70.
5. Khakinahad M, Ameri E, Ghandhari H, Tari H. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Acta Med Iran. 2012;50(7):477-81.
6. Mac-Thiong JM, Labelle H, Berthonnaud E, Betz RR, Roussouly P. Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J. 2007 Feb;16(2):227-34.
7. Mac-Thiong JM, Labelle H, Charlebois M, Huot MP, de Guise JA. Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type. Spine (Phila Pa 1976). 2003 Jul 1;28(13):1404-9.
8. Tanguay F, Mac-Thiong JM, de Guise JA, Labelle H. Relation between the sagittal pelvic and lumbar spine geometries following surgical correction of adolescent idiopathic scoliosis. Eur Spine J. 2007 Apr;16(4):531-6.
9. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001 Aug;83-A(8):1169-81.
10. Sucato DJ, Agrawal S, O'Brien MF, Lowe TG, Richards SB, Lenke L. Restoration of thoracic kyphosis after operative treatment of adolescent idiopathic scoliosis: a multicenter comparison of three surgical approaches. Spine (Phila Pa 1976). 2008 Nov 15;33(24):2630-6.
11. Jaquith BP, Chase A, Flinn P, Sawyer JR, Warner WC, Freeman BL, Kelly DM. Screws versus hooks: implant cost and deformity correction in adolescent idiopathic scoliosis. J Child Orthop. 2012 Jun;6(2):137-43.
12. Betz RR, Harms J, Clements DH 3rd, Lenke LG, Lowe TG, Shufflebarger HL, Jeszenszky D, Beele B. Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idiopathic scoliosis. Spine (Phila Pa 1976). 1999 Feb 1;24(3):225-39.
13. Rhee JM, Bridwell KH, Won DS, Lenke LG, Chotigavanichaya C, Hanson DS. Sagittal plane analysis of adolescent idiopathic scoliosis: the effect of anterior versus posterior instrumentation. Spine (Phila Pa 1976). 2002 Nov 1;27(21):2350-6.
14. Kim YJ, Lenke LG, Bridwell KH, Kim J, Cho SK, Cheh G, Yoon J. Proximal junctional kyphosis in adolescent idiopathic scoliosjjjjjkkis after 3 different types of posterior segmental spinal instrumentation and fusions: incidence and risk factor analysis of 410 cases. Spine (Phila Pa 1976). 2007 Nov 15;32(24):2731-8.
15. Legarreta CA, Barrios C, Rositto GE, Reviriego JM, Maruenda JI, Escalada MN, Piza-Vallespir G, Burgos J, Hevia E. Cervical and thoracic sagittal misalignment after surgery for adolescent idiopathic scoliosis: a comparative study of all pedicle screws versus hybrid instrumentation. Spine (Phila Pa 1976). 2014 Jul 15;39(16):1330-7.