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Thoracic Curve Correction Ratio: An Objective Measure to Guide against Overcorrection of a Main Thoracic Curve in the Setting of a Structural Proximal Thoracic Curve. J Clin Med 2022; 11:jcm11061545. [PMID: 35329871 PMCID: PMC8954637 DOI: 10.3390/jcm11061545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/04/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: The correction of double thoracic (Lenke 2) curves has been associated with higher rates of postoperative shoulder imbalance that may compromise long-term outcomes following spinal deformity correction. A number of methods have been proposed to mitigate this risk, though no accepted standard measurement exists. The purpose of this study is to validate a novel quantitative method of determining the relative curve correction magnitude in double thoracic curves. Methods: Retrospective data from a multi-center database of patients undergoing surgical correction of left-proximal thoracic, right-main thoracic Lenke 2 curves were analyzed. A novel measurement tool, the Thoracic Curve Correction Ratio (TCCR), was applied for the purposes of validation against historical data. Results: A total of 305 patients with complete two-year follow-up data were included. The TCCR, or the ratio of postoperative percent correction of the thoracic curves divided by the ratio of the preoperative curve magnitudes, displayed a significant negative correlation (Pearson R = −0.66; p < 0.001) with T1 tilt at two years postoperatively. Conclusions: The TCCR could be added as an important factor in the preoperative planning process and intraoperative assessment in order to reduce postoperative T1 tilt. While T1 tilt remains an imperfect surrogate measure for clinical shoulder balance, it serves as one of many potential measures that the surgeon may evaluate quantitatively and radiographically.
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Bram JT, Mehta N, Flynn JM, Anari JB, Baldwin KD, Yaszay B, Pahys JM, Cahill PJ. Sinister! The high pre-op left shoulder is less likely to be radiographically balanced at 2 years post-op. Spine Deform 2021; 9:451-460. [PMID: 33201494 DOI: 10.1007/s43390-020-00236-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE AIS patients consider shoulder balance an important cosmetic outcome after surgery. We examined the impact of preoperative left shoulder elevation (LSE) and choice of upper instrumented vertebra (UIV) on postoperative shoulder imbalance (PostSI). METHODS This was a retrospective cohort study utilizing a prospective AIS database. Patients had Lenke type 1-4 curves and preoperative shoulder height ≥ 1.0 cm. Patients with preoperative LSE and right shoulder elevation (RSE) were compared. Shoulder height difference < 1 cm was considered 'mild', 1-2 cm was 'moderate', and ≥ 2.0 cm was 'severe'. RESULTS 407 patients had ≥ 1.0 cm imbalance preoperatively, with 88 (21.6%) LSE. There were no differences in gender (p = 0.855) or age (p = 0.477). Patients with LSE more frequently had Lenke type 2 curves (43.2% vs 16.3%, p < 0.001), while preoperative RSE averaged 1.9 ± 0.9 cm versus 1.6 ± 0.5 cm for LSE (p < 0.001). Those with LSE more often had severe PostSI at 2 years (30.7% vs 5.0%, p < 0.001), and only 26.1% of patients with severe preoperative LSE corrected to mild. In contrast, most patients with RSE had mild PostSI regardless of initial imbalance. When examining only LSE patients, there was no difference in preoperative SH by final UIV (p = 0.101). Further, UIV choice did not impact the proportion of severely unbalanced patients postoperatively (p = 0.446). A PTC > 34.5° was predictive of PostSI ≥ 2.0 cm for patients with preoperative LSE. CONCLUSION AIS patients with preoperative LSE are less likely to achieve level shoulders postoperatively. Choice of higher UIV did not affect postoperative shoulder imbalance in this cohort. A PTC > 34.5° was predictive of severe PostSI in patients with preoperative LSE. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Joshua T Bram
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Nishank Mehta
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - John M Flynn
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Jason B Anari
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Keith D Baldwin
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Burt Yaszay
- Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA
| | - Patrick J Cahill
- The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Robert M. Campbell Jr. Endowed Chair in Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Wood Building, 2nd floor, 34th Street and Civic Center Blvd., Philadelphia, PA, 19104, USA.
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Koller H, Mayer M, Koller J, Ferraris L, Wiedenhöfer B, Hitzl W, Hempfing A. Temporary treatment with magnetically controlled growing rod for surgical correction of severe adolescent idiopathic thoracic scoliosis greater than 100°. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:788-796. [PMID: 33409729 DOI: 10.1007/s00586-020-06709-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 10/02/2020] [Accepted: 12/23/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Correction of severe idiopathic scoliosis poses surgical challenges. Treatment options entail anterior and/or posterior release, Halo-gravity traction (HGT) and three-column osteotomies (3CO). The authors report results with a novel technique of temporary short-term magnetically controlled growing rod (MCGR) as part of a posterior-only strategy to treat severe idiopathic major thoracic curves (MTC). METHODS Seven patients with MTC > 100° treated with temporary MCGR were included. Mean age was 15 years. Preoperative MTC was av. 118° and TC-flexibility av. 19.8%. Patients underwent posterior instrumentation, periapical release using advanced Ponte osteotomies, segmental insertion of pedicle screws and a single MCGR. After av. 14 days, the second surgery was performed with removal of MCGR and final correction and fusion. The spinal height from lowest instrumented vertebra (LIV) to T1 was measured. MTC-correction and scoliosis correction index (SCI) were calculated. RESULTS No patient suffered a major complication or neurologic deficit. Instrumentation was from T2 to L3 or L4. This kind of staged surgery achieved a correction of postop MTC to av. 39°, MTC-correction 67% and SCI of av. 4.3. Spinal height T1-LIV increased from preoperative av. 288 mm to postoperative av. 395 mm indicating an increase of > 10 cm. CONCLUSION This is the first series of AIS patients that had temporary MCGR to treat severe thoracic scoliosis. A staged protocol including internal temporary distraction with MCGR after posterior release and definitive correction resulted in large MTC-correction and restoration of trunk height. Results indicate that technique has the potential to reduce the necessity for HGT and high-risk 3CO for the correction of severe scoliosis.
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Affiliation(s)
- Heiko Koller
- Department of Neurosurgery, Technical University of Munich (TUM), Klinikum Rechts Der Isar, 81675, Munich, Germany. .,Paracelsus Medical University, Salzburg, Austria.
| | - Michael Mayer
- Paracelsus Medical University, Salzburg, Austria.,Spine Center Stiglmaierplatz, Nymphenburgerstrasse 1, 80335, Munich, Germany
| | | | | | | | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, Salzburg, Austria
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Okada E, Suzuki T, Demura S, Saito T, Nohara A, Tsuji T, Uno K, Kawakami N, Matsumoto M, Watanabe K. Excessive correction impacts postoperative shoulder imbalance in lenke type 5C adolescent idiopathic scoliosis. J Orthop Sci 2020; 25:757-762. [PMID: 31668913 DOI: 10.1016/j.jos.2019.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/19/2019] [Accepted: 10/01/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Postoperative shoulder imbalance (PSI) has a negative impact on the surgical outcomes of patients with adolescent idiopathic scoliosis. This study aimed to evaluate the risk factors of PSI in patients with Lenke type 5C curves. METHODS This study included 100 patients who underwent posterior correction surgery using pedicle screw constructs for Lenke type 5C curves. The mean age of the patients at surgery was 15.5 ± 2.3 years, and the mean follow-up period was 36.6 ± 15.0 months. The subjects were classified into the following two groups: PSI and non-PSI. Radiographic parameters, including the preoperative and 2-year postoperative coronal and sagittal profiles, were compared between the two groups. RESULT PSI was found in eight patients (8.0%). The preoperative Cobb angles were 47.3° ± 8.7° and 48.0° ± 3.9° in the non-PSI and PSI groups, respectively. The correction rate in the PSI group was significantly higher than that in the non-PSI group (81.0% ± 17.7% vs. 67.7% ± 14.7%; p = 0.018). The preoperative T1 tilt angle in the PSI group was significantly larger than that in the non-PSI group (6.1° ± 3.3° vs. 3.1° ± 2.8°; p = 0.005). Receiver operating characteristic (ROC) analysis showed that the area under the ROC curve was 0.769 (p = 0.012, 95% confidence interval [CI], 0.556-0.982) and 0.763 (p = 0.014, 95% CI, 0.598-0.928) for the correction rate and preoperative T1 tilt, respectively. The cut-off value was 73% and 4° for the correction rate and preoperative T1, respectively. CONCLUSION PSI was found in 8.0% of Lenke type 5C curves. Excessive correction of the lumbar curve of >73% and preoperative T1 tilt of >4° can be risk factors for PSI in patients with Lenke type 5C curve.
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Affiliation(s)
- Eijiro Okada
- Keio University School of Medicine, Department of Orthopaedic Surgery, Tokyo, Japan; Japan Spinal Deformity Institute, Nagoya, Japan
| | - Teppei Suzuki
- Kobe Medical Center, Department of Orthopaedic Surgery, Kobe, Japan; Japan Spinal Deformity Institute, Nagoya, Japan
| | - Satoru Demura
- Kanazawa University, Department of Orthopaedic Surgery, Kanazawa, Japan; Japan Spinal Deformity Institute, Nagoya, Japan
| | - Toshiki Saito
- Meijo Hospital, Department of Orthopaedic Surgery, Nagoya, Japan; Japan Spinal Deformity Institute, Nagoya, Japan
| | - Ayato Nohara
- Tokyo Shinjuku Medical Center, Department of Spine Surgery, Tokyo, Japan; Japan Spinal Deformity Institute, Nagoya, Japan
| | - Taichi Tsuji
- Toyota Kosei Hospital, Department of Orthopaedic Surgery, Toyota, Japan; Japan Spinal Deformity Institute, Nagoya, Japan
| | - Koki Uno
- Kobe Medical Center, Department of Orthopaedic Surgery, Kobe, Japan; Japan Spinal Deformity Institute, Nagoya, Japan
| | - Noriaki Kawakami
- Meijo Hospital, Department of Orthopaedic Surgery, Nagoya, Japan; Japan Spinal Deformity Institute, Nagoya, Japan
| | - Morio Matsumoto
- Keio University School of Medicine, Department of Orthopaedic Surgery, Tokyo, Japan; Japan Spinal Deformity Institute, Nagoya, Japan
| | - Kota Watanabe
- Keio University School of Medicine, Department of Orthopaedic Surgery, Tokyo, Japan; Japan Spinal Deformity Institute, Nagoya, Japan.
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Ng BW, Chau WW. Changes of shoulder balance, sagittal alignments, and curve correction in the treatment of Lenke 1 and 2 adolescent idiopathic scoliosis using a three-dimensional-based correction strategy in correlation to health-related quality of life using the Scoliosis Research Society-22 Questionnaire. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2020. [DOI: 10.4103/jotr.jotr_46_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Koller H, Hitzl W, Marks MC, Newton PO. Accurate prediction of spontaneous lumbar curve correction following posterior selective thoracic fusion in adolescent idiopathic scoliosis using logistic regression models and clinical rationale. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1987-1997. [PMID: 31236658 DOI: 10.1007/s00586-019-06000-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 04/17/2019] [Accepted: 05/05/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Accurate prediction of spontaneous lumbar curve correction (SLCC) after selective thoracic fusion (STF) remains difficult. This study sought to improve prediction accuracy of SLCC. The hypothesis was preoperative and intraoperative variables could predict SLCC < 20°. METHODS A multicenter observational prospective analysis was conducted to determine predictors of SLCC in AIS patients that had posterior STF. Curve types included major thoracic curves (Lenke 1, 3-4).The primary outcome variable was to establish prediction models, and a postoperative lumbar curve (LC) ≤ 20° was defined as the target variable. Multivariate logistic regression models were established to study the relationship between selected variables and a LC ≤ 20° versus a LC > 20° at ≥ 2-year follow-up. Single and dual thresholds models in perspective of clinical rationales were applied to find models with the highest positive/negative predictive values (PPV/NPV). The secondary outcome measure was SRS scores at ≥ 2-year follow-up. RESULTS 410 patients were included. At ≥ 2-year follow-up 282 patients had LC ≤ 20°. These patients had better SRS-22 scores than those with LC > 20° (P = 0.02). The postoperative LC and LC ≤ 20° were predicted by preoperative LC and LC-bending Cobb angle (P < 0.01, r = 0.4-0.6). Logistic regression models could be established to identify patients at risk for failing the target LC ≤ 20°.For preoperative LC and LC-bending, the prediction model achieved a NPV/PPV of 80%/72%. If the postoperative main thoracic curve is combined with the preoperative LC and a gray area for difficult decisions was allowed, model accuracy could even be improved (NPV/PPV = 96%/81%). CONCLUSION An accurate prediction model for postoperative SLCC was established based on a large analysis of prospective STF cases. These models can support prediction and understanding of postoperative SLCC aiding in surgical decision making when contemplating a selective thoracic fusion. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- H Koller
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. .,Department for Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria.
| | - W Hitzl
- Research Office, Biostatistics, Paracelsus Medical University, Salzburg, Austria
| | - M C Marks
- Setting Scoliosis Straight, Harms Study Group, San Diego, USA
| | - P O Newton
- Department of Orthopedic Surgery, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA, USA
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Predictors of shoulder level after spinal fusion in adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:370-380. [DOI: 10.1007/s00586-017-5210-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
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Adding-on Phenomenon After Surgery in Lenke Type 1, 2 Adolescent Idiopathic Scoliosis: Is it Predictable? Spine (Phila Pa 1976) 2016; 41:698-704. [PMID: 26630420 DOI: 10.1097/brs.0000000000001303] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to detect risk factors for Adding-on after posterior correction surgery in patients with Lenke 1 or 2 AIS, and to explore whether Adding-on Index could be used to predict Adding-on effectively. SUMMARY OF BACKGROUND DATA Adding-on phenomenon is a common complication in Lenke 1 or 2 AIS patients after correction surgery. However, whether it can be predicted after surgery remains unknown. METHODS Lenke 1 or 2 AIS patients receiving correction surgery in our center from January 2009 to July 2013 were analyzed. Antero-posterior and lateral films were evaluated before surgery, at 2 weeks' and 2 years' follow-up. Patients were divided into 2 groups according to whether Adding-on occurred at the 2 years' follow-up. Risk factors of Adding-on were analyzed, and Adding-on Index was proposed and verified. RESULTS Sixteen patients (16.3%) suffered from distal Adding-on at 2-year follow-up. Several parameters were found to be significantly different between 2 groups, including Risser's sign, postoperative Cobb angle of main thoracic, postoperative Cobb angle of main thoracic curve at 2-year follow-up, preoperative and postoperative Cobb angle of lumbar curve, postoperative Cobb angle of lumbar curve at 2-year follow-up, LIV-EV, LIV-SV, LIV-CSVL, LAV-CSVL, LAV-LIV, DnfS, and postoperative TJK. No significant differences in SRS-22 scores were observed. Binary logistic regression analysis showed that DnfS and postoperative residual Cobb angle of lumbar curve were primary factors for occurrence of Adding-on. According to the regression equation, Adding-on Index was defined as 4 × DnfS-postoperative lumbar curves Cobb angle. On the basis of ROC curve, if Adding-on Index was more than 12, the occurrence rate of Adding-on was 88%. On the contrary, the rate of no Adding-on phenomenon was 80%. CONCLUSION DnfS and posterior Cobb angle of lumbar curve were 2 important factors for Adding-on in Lenke 1, 2 AIS patients. Adding-on Index can be used to predict the occurrence of Adding-on effectively. LEVEL OF EVIDENCE 4.
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