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Gu Q, Bao H, Shu S, Zhang X, Qiu Y, Zhu Z. Hyper-Selective Posterior Fusion is Recommended When the Modified S-Line is Positive in Lenke 5C Adolescent Idiopathic Scoliosis. Orthop Surg 2024; 16:1390-1398. [PMID: 38706032 PMCID: PMC11144515 DOI: 10.1111/os.14073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVE Postoperative coronal decompensation and less fusion level are dilemmas and the proper selective posterior fusion (SPF) strategy should be investigated. We proposed a parameter, modified S-line, and aimed to investigate if the modified S-line could predict postoperative coronal decompensation in patients with Lenke 5C adolescent idiopathic scoliosis (AIS). METHODS This is a retrospective radiographic study and Lenke 5C AIS patients undergoing SPF during the period from September 2017 to June 2021 were included. The modified S-line was defined as the line linking the centers of the concave-side pedicles of the upper end vertebra (UEV) and lower end vertebra (LEV) at baseline. A modified S-line tilt to the right is established as modified S-line+ (UEV being to the right of the LEV). The patients were further categorized into two groups: the Cobb to Cobb fusion group and the Cobb-1 to Cobb fusion group. Outcomes including thoracic Cobb angle, TL/L Cobb angle, coronal balance, upper instrumented vertebra (UIV) translation, lower instrumented vertebra (LIV) translation, UIV tilt, LIV tilt, LIV disc angle, thoracic apical vertebral translation, lumbar apical vertebral translation (L-AVT), L-T AVT ratio, L-T Cobb were measured at baseline, immediately after surgery, and the last follow-up. Radiographic parameters and the incidence of both proximal and distal decompensation between the two groups were compared by chi-square test. RESULTS Among 92 patients, 48 were modified S-line+ and 44 were modified S-line-. Modified S-line+ status was identified as a risk factor for postoperative proximal decompensation (p = 0.005) during follow-up. In Cobb to Cobb group, a higher occurrence of proximal decompensation in individuals with modified S-line+ status (p = 0.001) was confirmed. Also, in the Cobb to Cobb group with baseline modified S-line+ status, patients presenting decompensation showed a significantly larger baseline of the UIV tilt and postoperative disc angle below the lower instrumented vertebra. However, In Cobb-1 group, the incidence of decompensation after surgery showed no association with baseline modified S-line tilt status (p = 0.815 and 0.540, respectively). CONCLUSION The modified S-line could serve as an important parameter in surgical decision-making for Lenke 5C AIS patients. Cobb to Cobb SPF is not recommended with a modified S-line+ status, and the Cobb-1 to Cobb fusion may serve as a potential alternative.
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Affiliation(s)
- Qi Gu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital Clinical College of Nanjing Medical UniversityNanjingChina
| | - Hongda Bao
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Shibin Shu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Xin Zhang
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital Clinical College of Nanjing Medical UniversityNanjingChina
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
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Katzouraki G, Vasiliadis ES, Kaspiris A, Evangelopoulos DS, Grivas TB, Pneumatikos SG. Sagittal Balance Parameters and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis. J Clin Med 2024; 13:1895. [PMID: 38610660 PMCID: PMC11012752 DOI: 10.3390/jcm13071895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/17/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Background: To review and evaluate multiple preoperative and postoperative sagittal parameters and their association with the risk of developing proximal junctional kyphosis (PJK) in patients with adolescent idiopathic scoliosis (AIS) who undergo correction surgery. Methods: A systematic search was performed in December 2022 in PubMed, Embase and the Cochrane Library to retrieve all the studies relevant to our research. After the study selection and data extraction following PRISMA guidelines, RevMan 5.3 was used for statistical analysis. All the analyzed factors were evaluated by using odds ratios and weighted mean differences with 95% confidence intervals. Moreover, the meta-analysis of proportions via MedCalc was used for analyzing quantitative data from the studies. Results: A total of 22 studies were included in our meta-analysis. All the available values of sagittal parameters were evaluated. Among all the potential risk factors, higher preoperative thoracic kyphosis (Test for overall effect Z = 11.79, p < 0.00001), higher preoperative sagittal vertical axis (SVA) (test for overall effect Z = 11.19, p < 0.00001), greater thoracic kyphosis change post-op. compared to pre-op. (test for overall effect Z = 6.02, p < 0.00001), increased postoperative lumbar lordosis (test for overall effect Z = 3.65, p = 0.0003), higher post-op. SVA (test for overall effect Z = 24.93, p < 0.00001) and a larger pelvic incidence/lumbar lordosis (PI/LL) mismatch (test for overall effect Z = 20.50, p < 0.00001) were found to be the risk factors for PJK after AIS surgery. Moreover, a decreased rod contour angle (RCA) (test for overall effect Z = 3.79, p < 0.0002) and higher proximal junctional angle-rod contour angle (PJA-RCA) (test for overall effect Z = 39.18, p < 0.00001) play a significant role in the risk of developing PJK after AIS correction. Conclusions: Sagittal balance is of great importance when considering the surgical correction of AIS. Many factors in our meta-analysis were found to increase the incidence for PJK such as higher preoperative thoracic kyphosis and pre-op. SVA. Furthermore, increased thoracic kyphosis change, increased post-operative lumbar lordosis, SVA and PI/LL mismatch are also factors that influence the possibility of post-op. PJK. Lastly, RCA and PJA-RCA are two important factors that need attention during AIS, as over-contouring of the rod could lead to PJK in AIS patients.
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Affiliation(s)
- Galateia Katzouraki
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (G.K.); (A.K.); (D.-S.E.); (S.G.P.)
| | - Elias S. Vasiliadis
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (G.K.); (A.K.); (D.-S.E.); (S.G.P.)
| | - Angelos Kaspiris
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (G.K.); (A.K.); (D.-S.E.); (S.G.P.)
| | - Dimitrios-Stergios Evangelopoulos
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (G.K.); (A.K.); (D.-S.E.); (S.G.P.)
| | - Theodoros B. Grivas
- Former Head of Department of Orthopedics & Traumatology, “Tzaneio” General Hospital of Piraeus, 185 36 Piraeus, Greece;
| | - Spiros G. Pneumatikos
- 3rd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, KAT Hospital, 145 61 Athens, Greece; (G.K.); (A.K.); (D.-S.E.); (S.G.P.)
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Okubo T, Suzuki S, Ozaki M, Takahashi Y, Tsuji O, Nagoshi N, Matsumoto M, Nakamura M, Watanabe K. Influence of thoracolumbar kyphosis on postoperative spinal alignment in patients with Lenke type 5C adolescent idiopathic scoliosis. Spine Deform 2024; 12:411-422. [PMID: 37966710 DOI: 10.1007/s43390-023-00782-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/15/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE This study aimed to examine the changes in thoracolumbar kyphosis (TLK) following correction surgery in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS) and to evaluate its influence on postoperative spinal alignment and clinical outcomes. METHODS Sixty-six patients with Lenke type 5C AIS were included and followed up for a minimum of 5 years after surgery. First, the patients were divided into two groups according to the preoperative TLK angle (Study 1; Kyphosis and Lordosis group). The patients were further classified into two groups according to the presence or absence of postoperative changes in TLK (Study 2; Changed and Maintained groups). Finally, the outcome variables were compared between these groups and analyzed for spinal alignment and clinical outcomes. RESULTS In Study 1, patients demonstrated a significant kyphotic change in the Lordosis group and a significant lordotic change in the Kyphosis group postoperatively. No statistically significant differences were found between the two groups when comparing the pre- and postoperative coronal and sagittal alignment. In Study 2, there were no statistically significant differences between the Changed and the Maintained groups in each spinal alignment pre- and postoperatively. Each domain of the Scoliosis Research Society 22-item questionnaire remained unchanged at 5 years postoperation. CONCLUSION In many patients with Lenke type 5C AIS, TLK changed significantly and approached 0° after surgery. However, the magnitude of the preoperative TLK and the presence or absence of improvement did not affect postoperative spinal alignment. Furthermore, the patients had satisfactory clinical outcomes irrespective of TLK modification. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yohei Takahashi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
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Updated Criteria for Fusion Level Selection in Adolescent Idiopathic Scoliosis Including Use of Three-Dimensional Analysis. J Am Acad Orthop Surg 2023; 31:e298-e307. [PMID: 36649219 DOI: 10.5435/jaaos-d-21-01175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/13/2022] [Indexed: 01/18/2023] Open
Abstract
The development of new technologies and an enhanced understanding of the three-dimensional deformity in adolescent idiopathic scoliosis has led to advances in surgical management of adolescent idiopathic scoliosis. Posterior spinal approaches with pedicle screw constructs are now standard of care because they allow for powerful rotation maneuvers with three-column deformity correction. Selective fusion of the main curve while allowing for spontaneous correction of compensatory curves should be attempted whenever possible in the interest of limiting fusion size and preserving spinal mobility. Recent research provides updated criteria to determine optimal candidates for selective fusion. These criteria must be weighed against patient goals and patient-specific factors to limit complications and maximize chances of successful deformity correction.
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Bowden D, Michielli A, Merrill M, Will S. Systematic review and meta-analysis for the impact of rod materials and sizes in the surgical treatment of adolescent idiopathic scoliosis. Spine Deform 2022; 10:1245-1263. [PMID: 35737287 PMCID: PMC9579082 DOI: 10.1007/s43390-022-00537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess surgical and safety outcomes associated with different rod materials and diameters in adolescent idiopathic scoliosis (AIS) surgery. METHODS A systematic literature review and meta-analysis evaluated the surgical management of AIS patients using pedicle screw fixation systems (i.e., posterior rods and pedicle screws) with rods of different materials and sizes. Postoperative surgical outcomes (e.g., kyphosis and coronal correction) and complications (i.e., hyper/hypo-lumbar lordosis, proximal junctional kyphosis, revisions, reoperations, and infections) were assessed. Random-effects models (REMs) pooled data for outcomes reported in ≥ 2 studies. RESULTS Among 75 studies evaluating AIS surgery using pedicle screw fixation systems, 46 described rod materials and/or diameters. Two studies directly comparing titanium (Ti) and cobalt-chromium (CoCr) rods found that CoCr rods provided significantly better postoperative kyphosis angle correction vs. Ti rods during a shorter follow-up (0-3 months, MD = - 2.98°, 95% CI - 5.79 to - 0.17°, p = 0.04), and longer follow-up (≥ 24 months, MD = - 3.99°, 95% CI - 6.98 to - 1.00, p = 0.009). Surgical infection varied from 2% (95% CI 1.0-3.0%) for 5.5 mm rods to 4% (95% CI 2.0-7.0%) for 6 mm rods. Reoperation rates were lower with 5.5 mm rods 1% (95% CI 0.0-3.0%) vs. 6 mm rods [6% (95% CI 2.0-9.0%); p = 0.04]. Differences in coronal angle, lumbar lordosis, proximal junctional kyphosis, revisions, and infections did not differ significantly (p > 0.05) among rods of different materials or diameters. CONCLUSION For AIS, CoCr rods provided better correction of thoracic kyphosis compared to Ti rods. Patients with 5.5 mm rods had fewer reoperations vs. 6.0 and 6.35 mm diameter rods. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dawn Bowden
- DePuy Synthes Spine, Johnson & Johnson Medical Devices, 325 Paramount Drive, Raynham, MA, 02767, USA.
| | - Annalisa Michielli
- DePuy Synthes Spine, Johnson & Johnson Medical Devices, 325 Paramount Drive, Raynham, MA, 02767, USA
| | - Michelle Merrill
- DePuy Synthes Spine, Johnson & Johnson Medical Devices, 325 Paramount Drive, Raynham, MA, 02767, USA
| | - Steven Will
- DePuy Synthes Spine, Johnson & Johnson Medical Devices, 325 Paramount Drive, Raynham, MA, 02767, USA
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Proximal junctional kyphosis in pediatric spinal deformity surgery: a systematic review and critical analysis. Spine Deform 2022; 10:257-266. [PMID: 34704232 DOI: 10.1007/s43390-021-00429-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Proximal junctional kyphosis (PJK) is a commonly encountered clinical and radiographic phenomenon after pediatric and adolescent spinal deformity surgery that may lead to post-operative deformity, pain, and dissatisfaction. Understanding the risk factors of PJK can be useful for pre-operative informed consent as well as to identify any potential preventative strategies. METHODS We performed a systematic review and critical analysis following the PRISMA statement in July 2019 by searching the PubMed, Scopus, and Embase databases, including all prior published studies. We included articles with data on PJK in patients with operative pediatric and adolescent scoliosis and those that detailed risk factors and/or preventative strategies for PJK. Levels of evidence were determined based on consensus. Findings were summarized and grades of recommendation were assigned by consensus. This study was registered in the PROSPERO database; 202,457. RESULTS Six hundred and thirty five studies were identified. Thirty-seven studies met criteria for inclusion into the analysis. No studies including neuromuscular scoliosis met inclusion criteria. No findings had Grade A evidence. There were 4 findings found to contribute to PJK with Grade B evidence in EOS: higher number of distractions, disruption of posterior elements, greater sagittal plane correction. There was no difference in incidence noted between etiology of the curvature. Five findings with Grade B evidence were found to contribute to PJK in AIS populations: higher pre-operative thoracic kyphosis, higher pre-operative lumbar lordosis, longer fusion constructs, greater sagittal plane correction, and posterior versus anterior fusion constructs. CONCLUSION Greater sagittal plane correction has Grade B evidence as a risk factor for PJK in both EOS and AIS populations. In EOS patients, an increased number of distractions and posterior element disruption are Grade B risk factors. In AIS patients, longer fusion constructs, higher pre-operative thoracic kyphosis and lumbar lordosis, and posterior (as opposed to anterior) constructs also contributed to PJK with Grade B evidence. These findings can guide informed consent and surgical management, and provide the foundation for future studies.
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Anterior versus posterior spinal fusion for Lenke type 5 adolescent idiopathic scoliosis: a systematic review and meta-analysis of comparative studies. Spine Deform 2022; 10:267-281. [PMID: 34725791 DOI: 10.1007/s43390-021-00436-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To review and compare clinical and radiologic outcomes between anterior spinal fusion (ASF) and posterior spinal fusion (PSF) for the treatment of Lenke type 5 adolescent idiopathic scoliosis (AIS). METHODS A systematic review was performed according to Preferred reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. All level I-III evidence studies investigating the clinical and radiologic outcomes of ASF and PSF for the treatment of Lenke type 5 AIS were included. RESULTS Nine studies (285 ASF patients, 298 PSF patients) were included. ASF was associated with a significantly lower number of levels fused compared with PSF (p < 0.01) with similar immediate and long-term coronal deformity correction (p = 0.16; p = 0.12, respectively). PSF achieved a better correction of thoracic hypokyphosis in one study and lumbar hypolordosis in three studies. PSF was associated with a significant shorter length of stay (LOS) compared with ASF (p < 0.01). One long-term study demonstrated a significantly higher rate of proximal junctional kyphosis (PJK) with PSF compared with ASF. There were no significant differences in major complication or re-operation rates. CONCLUSION For the treatment of Lenke type 5 AIS, there is moderate evidence to suggest that ASF requires a lower number of instrumented levels to achieve similar immediate and long-term coronal deformity correction compared with PSF. There is some evidence to suggest that PSF may achieve better thoracic and lumbar sagittal deformity correction compared with ASF. There is some evidence to suggest a higher incidence of PJK at long-term follow-up with PSF compared with ASF. ASF is associated with a longer post-operative LOS compared with PSF.
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Wang ZW, Shen YQ, Wu Y, Li J, Liu Z, Xu JK, Chen QX, Chen WS, Chen LW, Zhang N, Li FC. Anterior Selective Lumbar Fusion Saving More Distal Fusion Segments Compared with Posterior Approach in the Treatment of Adolescent Idiopathic Scoliosis with Lenke Type 5: A Cohort Study with More Than 8-Year Follow-up. Orthop Surg 2021; 13:2327-2334. [PMID: 34755473 PMCID: PMC8654659 DOI: 10.1111/os.13117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/28/2021] [Accepted: 05/26/2021] [Indexed: 02/05/2023] Open
Abstract
Objective To investigate whether anterior selective fusion (ASF) could save more distal fusion segments compared with posterior approach in the treatment of Lenke type 5 adolescent idiopathic scoliosis with long term follow‐up. Methods A retrospective cohort study. From 2008 to 2011, 22 AIS girls with Lenke type 5 who underwent ASF or posterior selective fusion (PSF) with more than 8‐year follow‐up, were extracted from the database. 13 girls in the ASF group had an average age of 14.3 ± 1.3 years and Risser sign of 3.3 ± 1.1; 9 PSF girls had an average age of 16.2 ± 3.6 years and Risser sign of 3.8 ± 1.5. The radiographic outcome was compared between groups preoperatively, 6‐month postoperatively, 8‐year postoperatively and at last follow‐up (>8 years). Results The average follow‐up duration was 8.7 ± 0.4 (ASF) and 8.8 ± 0.5 (PSF) years, respectively. There was no significant difference at baseline in age, Risser sign and preoperative curve pattern in the coronal and sagittal plane between the groups (P > 0.05). The ASF group had significantly shorter fusion segments (5.1 ± 0.6 vs. 7.0 ± 1.3) and decreased upper instrumented vertebra (UIV) (T11 ± 0.8 vs. T10 ± 0.8) than the PSF (P < 0.05); while no significant difference was found in the lower instrumented vertebra (LIV) and distal reserved segments (P > 0.05), which suggested that ASF could shorten the fusion segments by lowering UIV. The distal compensatory curve in the ASF group (9.0° ± 3.9°) was significantly larger than in the PSF group (3.3° ± 2.4°, P = 0.003), despite of no significant difference in the incidence of coronal imbalance (P > 0.05), indicating that both two approaches could obtain satisfactory correction in the coronal plane. In the sagittal plane, PSF patients had significantly larger lumbar lordosis (LL, 59.1° ± 10.5°), thoracic kyphosis (TK, 37.2° ± 13.3°) and proximal junctional angle (PJA, 13.3° ± 6.1°) at the last follow‐up than the ASF (LL: 43.4° ± 9.4°; TK: 20.7° ± 8.4°; PJA: 4.7° ± 3.4°; P < 0.05), but without significant difference in proximal junctional kyphosis (PJK) and sagittal vertical axis (SVA) (P > 0.05). After controlling for age, Risser sign, and radiographic parameters related to the primary curve pattern, shorter fusion segments and more distal reserved segments still remained significant in the ASF group with greater Risser sign (P < 0.05). No major intra‐ or post‐operative complications occurred. Conclusions Both ASF and PSF could obtain satisfactory coronal and sagittal correction for Lenke 5 AIS; compared with PSF, ASF could shorten the fusion segments by lowering UIV, and save more distal fusion segments only in patients with greater skeletal maturity.
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Affiliation(s)
- Zhi-Wei Wang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou City, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Yuan-Qing Shen
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Wu
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou City, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Jun Li
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou City, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zhen Liu
- Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Jian-Kun Xu
- Department of Orthopaedics, the First Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Qi-Xin Chen
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou City, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Wei-Shan Chen
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou City, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Lin-Wei Chen
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou City, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Ning Zhang
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou City, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Fang-Cai Li
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute of Zhejiang University, Hangzhou City, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
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Zhou Y, Xin D, Lei Z, Zuo Y, Zhao Y. Comparative Three-Dimensional Finite Element Analysis of 4 Kinds of Pedicle Screw Schemes for Treatment of Adult Degenerative Scoliosis. Med Sci Monit 2020; 26:e922050. [PMID: 32536684 PMCID: PMC7315803 DOI: 10.12659/msm.922050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to evaluate the biomechanical stress of the internal fixation screws and vertebral bodies after the full-segment, interval, key vertebral, and strategy pedicle screw fixations under 7 work conditions in a patient with adult degenerative scoliosis (ADS) using finite elements (FE) analysis. Material/Methods A patient with ADS underwent internal fixation by pedicle screws after posterior incision in combination with subtotal laminectomy decompression and bone graft fusion, and received thin-layer computed tomography (CT) spine scanning at T12–L5. The CT data were used to constitute three-dimensional FE full-segment, interval, key vertebral, and strategic pedicle screw models. The stress of each screw-rod system under different working conditions was evaluated. Results Forward flexion, backward extension, lateral flexion, and rotation greatly increased the force of the pedicle screw systems. The maximum stress of the screw-rods was the lowest in the full-segment model under almost all the working conditions except for the upright situation. The maximum stress of the vertebral bodies was the minimum in the strategic model under all the 7 working conditions, followed by that in the key vertebra and full-segment models. Conclusions Collectively, the strategic and key vertebra pedicle screw schemes can decrease the biomechanical stress of screw-rod systems and vertebral bodies, which is close to the full-segment scheme. Our results may help explore the optimal surgical means for pedicle screw fixation for ADS patients, which can maximally reduce the risk of screws-related postoperative complications and simultaneously maintain a reasonable 3D orthopedic effect.
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Affiliation(s)
- Yang Zhou
- Graduate School of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Daqi Xin
- Department of Thoracic and Lumbar Spine Surgery, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Zhuoting Lei
- College of Traditional Chinese Medicine, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Yuan Zuo
- Department of Laboratory Medicine, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Yan Zhao
- Department of Laboratory Medicine, Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
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Ogura Y, Okada E, Fujii T, Yagi M, Fujita N, Suzuki S, Hosogane N, Kitagawa T, Tsuji O, Nagoshi N, Nakamura M, Matsumoto M, Watanabe K. Midterm surgical outcomes of a short fusion strategy for adolescent idiopathic scoliosis with Lenke 5C curve. Spine J 2020; 20:361-368. [PMID: 31622677 DOI: 10.1016/j.spinee.2019.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/08/2019] [Accepted: 09/10/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A previous study examined the short-term (2 years) outcomes of a short fusion strategy for Lenke type 5C curves. This strategy had a little less correction rate with no difference in coronal and sagittal balance and SRS-22 scores to those of a conventional strategy and was superior in operative time and intraoperative bleeding. However, its effectiveness in longer follow-up periods was unknown. PURPOSE To assess midterm surgical outcomes of a short fusion strategy for adolescent idiopathic scoliosis (AIS) with Lenke type 5C curve, involving posterior correction and fusion surgery (PSF) using pedicle-screw constructs. STUDY DESIGN Retrospective case series. PATIENT SAMPLE Twenty-nine patients who underwent PSF for AIS with Lenke type 5C curve with a minimum 5-year follow-up. OUTCOME MEASURES Radiographic parameters and SRS-22. METHODS We compared radiographic parameters and clinical outcomes between patients with an upper instrumented vertebra (UIV) at the end vertebra (EV) (n=12) and those treated by short fusion (S), with a UIV one level caudal to the EV (n=17). RESULTS A preoperative mean Cobb angle of 51.9±13.8° was corrected to 11.7±7.7° in the EV group, and an angle of 46.0±6.6° was corrected to 9.3±5.2° in the S group. The correction was maintained in both groups at the final follow-up, and the mean correction loss was 2.8±6.8° in the EV and 6.5±6.5° in the S group (p=.143). The mean correction rate at the final follow-up was not significantly different between the EV (71.4±11.8%) and S (64.9±13.7%) groups (p=.199). A Cobb angle of a thoracic curve was significantly improved immediately after surgery and maintained during the follow-up period in the both groups. Coronal and sagittal balance, thoracic kyphosis, lumbar lordosis, L4 tilt, UIV/LIV tilt, shoulder balance, and SRS-22 had no difference between the two groups. CONCLUSIONS There was no difference in radiographic parameters and SRS-22 between patients treated with a UIV at the UEV and patients treated using a short fusion strategy, in which the UIV was one level caudal to the UEV. The short fusion strategy can be one of the alternatives in PSF for Lenke type 5C curves, at least in 5-year time frame.
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Affiliation(s)
- Yoji Ogura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takeshi Fujii
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Naobumi Hosogane
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takahiro Kitagawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Abstract
STUDY DESIGN A systematic review. OBJECTIVE To systemically review the previous literature regarding surgical treatment of Lenke type 5 adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The Lenke classification was published in 2001 as the classification of AIS. Since then, numerous articles have been published reporting the outcomes of surgical treatment of Lenke type 5 AIS. METHODS The electronic databases PubMed, EMBASE, and Web of Science were queried up to Aug 2018 for articles regarding surgical treatment of Lenke type 5 AIS. Surgical variables, radiographic assessments, and clinical outcomes of surgical treatment of Lenke type 5 AIS were summarized. RESULTS Fifty studies met the inclusion criteria. The average fused levels, % correction of thoracolumbar/lumbar curve at final follow-up, and % correction of thoracic curve at final follow-up for anterior and posterior procedures were reported to be 3.6-5.3 and 4.3-7.8 levels, 53-86 and 55-94% and 17-52 and 19-67%, respectively. Average coronal balance was imbalanced (≥20 mm) at preoperation in 22/43 reporting study groups and balanced (<20 mm) at final follow-up in all 37 reporting study groups. Scoliosis Research Society Version 22 scores showed no difference between anterior and posterior procedures in most of the reporting studies (5/6). CONCLUSION Overall, the outcomes of surgical treatment of Lenke type 5 AIS are excellent. The thoracic curve was spontaneously corrected after surgery and coronal balance after surgery was better than before surgery. Both anterior and posterior procedures demonstrated satisfactory outcomes. LEVEL OF EVIDENCE 4.
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