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Kinoshita Y, Matsumura A, Namikawa T, Hoshino M, Hori Y, Nakamura H. Analyzing Factors Associated with Postoperative Shoulder Imbalance in Lenke2 Adolescent Idiopathic Scoliosis (Retrospective Cohort Study). World Neurosurg 2024:S1878-8750(24)01013-1. [PMID: 38897402 DOI: 10.1016/j.wneu.2024.06.055] [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: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To assess the incidence of postoperative shoulder imbalance (PSI) following posterior spinal fusion surgeries in adolescent idiopathic scoliosis (AIS) with Lenke2 and calculate the risk factors for PSI. METHODS Sixty patients who underwent surgery for Lenke2 AIS with more than 2-year follow-up were selected. Radiographic parameters were measured before and after surgery, and at the latest follow-up. The patients were divided into PSI and non-PSI groups, with PSI defined as a radiographic shoulder height >15 mm on postoperative radiography. The factors were compared between the PSI and non-PSI groups using the Mann-Whitney U test or chi-squared test. Finally, explanatory variables were chosen for multivariate analysis based on previous studies. RESULTS The PSI group comprised 17 patients. Most PSI cases spontaneously improved, and four patients (6.7%) showed PSI at the final follow-up. Univariate analysis indicated significant differences between postoperative T1 tilt (9.00 ± 5.17 vs. 5.67 ± 4.02, P = 0.029), UIV tilt (1.94 ± 4.49 vs. -1.00 ± 5.04, P = 0.039), and ΔT1 tilt (4.82 ± 3.99 vs. 2.12 ± 3.77, P = 0.026). Multivariate logistic regression analysis indicated that ΔT1 tilt had a significant positive relationship with PSI occurrence (coefficient = 0.2541, 95% confidence interval [CI]: 0.023 to 0.485, P = 0.0310). This study found no significant differences in the SRS-22 scores at the final follow-up. CONCLUSIONS The incidence of PSI for Lenke2 AIS was 28.3% at 1 week postoperatively and 6.7% at the final follow-up. ΔT1 tilt was a risk factor for PSI. Adjustment of the T1 tilt during surgery was considered useful for the prevention of PSI.
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Affiliation(s)
- Yuki Kinoshita
- Department of Orthopedic Surgery, Scoliosis Center, Osaka City General Hospital, Osaka, Japan
| | - Akira Matsumura
- Department of Orthopedic Surgery, Scoliosis Center, Osaka City General Hospital, Osaka, Japan.
| | - Takashi Namikawa
- Department of Orthopedic Surgery, Scoliosis Center, Osaka City General Hospital, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopedic Surgery, Scoliosis Center, Osaka City General Hospital, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopedic Surgery, Scoliosis Center, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Lee SY, Ch'ng PY, Wong TS, Ling XW, Chung WH, Chiu CK, Chan CYW, Lean ML, Kwan MK. Patients' Perception and Satisfaction on Neck and Shoulder Imbalance in Adolescent Idiopathic Scoliosis. Global Spine J 2023; 13:752-763. [PMID: 33823628 DOI: 10.1177/21925682211007795] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To evaluate the perception and satisfaction among adolescent idiopathic scoliosis (AIS) patients on Neck Tilt with Medial Shoulder Imbalance and Lateral Shoulder Imbalance. METHODS Lenke 1 and 2 AIS patients were stratified into 6 groups of preoperative/ postoperative Balanced (B), Lateral Shoulder Imbalance (LSI) (>2 cm), and Neck Tilt with Medial Shoulder Imbalance (NT) (Grade 3). Patients were interviewed using Modified Neck and Shoulder Appearance and SRS-22r questionnaires. T1 tilt, Cervical Axis (CA), Clavicle Angle (Cla-A) and Radiographic Shoulder Height (RSH) were measured. RESULTS A total of 120 Lenke 1 and 2 AIS patients were recruited. NT patients were aware and unhappy with their abnormal neck with medial shoulder appearances (P < .001). Similarly, LSI patients were aware and unhappy with their abnormal lateral shoulder appearances (P < .001). NT group had larger preoperative/ postoperative T1 tilt (9.2 ± 5.0°; 9.5 ± 5.3°) and CA (4.6 ± 3.1°; 7.0 ± 2.0°) (P < .01). LSI group had larger preoperative/ postoperative Cla-A (4.8 ± 2.8°; 4.0 ± 1.3°) and RSH (20.1 ± 9.4 mm; 17.0 ± 6.6 mm) (P < .001). Postoperative B group scored higher in overall SRS-22r scores, self-image and satisfaction domains (4.2 ± 0.3; 4.0 ± 0.5; 4.4 ± 0.5) while preoperative LSI scored the lowest comparatively (3.5 ± 0.4; 2.4 ± 0.5; 3.3 ± 0.5) (P < .001). CONCLUSION NT and LSI were major concerns among AIS patients. Both NT and LSI groups were unhappy with their appearances. NT group had larger T1 tilt/ CA whereas LSI group had larger Cla-A/ RSH. Postoperative B group scored higher in overall SRS-22r scores, self-image and satisfaction domains.
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Affiliation(s)
- Sin Ying Lee
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Pei Ying Ch'ng
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Tat Seng Wong
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Xiu Wen Ling
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Mei Li Lean
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
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Nikouei F, Ghandhari H, Ameri E, Mokarami F. Shoulder Imbalance in Adolescent Idiopathic Scoliosis: A Systematic Review of the Current State of the Art. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:992-1003. [PMID: 36721654 PMCID: PMC9846726 DOI: 10.22038/abjs.2022.64282.3086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 10/02/2022] [Indexed: 02/02/2023]
Abstract
Background Shoulder imbalance (SI) is among the most rated manifestations of adolescent idiopathic scoliosis (AIS) pointed to by patients and spine surgeons. It serves as a criterion to assess the outcome of scoliosis surgery and is also a cause of dissatisfaction for the patients postoperatively. Despite the availability of multiple studies on this issue, a comprehensive survey of the risk factors and preventive measures has yet to be elucidated. The present study aimed to highlight the most recent approach to the evaluation and management of SI, as well as medical counseling about the expectations and limitations of the surgery. Methods A systematic literature review using electric databases was conducted, including PubMed, Embase, the Cochrane Library, and Google Scholar, with a well-defined search strategy on SI definition, risk factors, and preventive and surgical recommendations. Results A total of 69 articles were identified; SI > 2 cm was the most used cut-off, and its risk factors included the main thoracic Cobb angle > 80˚, preoperative level shoulder, high left shoulder, and higher Risser grade. The most stated strategies to preclude SI were the sufficient correction of the proximal thoracic curve, and moderate correction of the main thoracic and lumbar curve (LC). Conclusion Shoulder imbalance should be prevented not only for appearance or satisfaction but also for possible complications such as distal adding-on, new LC progression, or trunk shift postoperatively in AIS patients.
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Affiliation(s)
- Farshad Nikouei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Ghandhari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Ameri
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farzam Mokarami
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Zhang H, Wang B, Wu A, Huang C, Pan X, Chen B, Ni L, Shi Y, Meftah ZAM, Wang X. Assessment of Neck Imbalance in Adolescent Idiopathic Scoliosis Patients: A Cross-Section Study Based on Body Image of 115 Patients with Main or Double Thoracic Curve. Orthop Surg 2022; 15:572-578. [PMID: 36419322 PMCID: PMC9891929 DOI: 10.1111/os.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/25/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Neck imbalance negatively affects body aesthetics of adolescent idiopathic scoliosis (AIS) patients. The evaluation of neck imbalance is currently limited to radiographic parameters, but lacks visual indicators. Therefore, the purpose of this study was to establish indexes of neck imbalance based on body image and to investigate whether these indexes can truly reflect neck imbalance in AIS patients. METHODS We performed a cross-sectional study at a single institution between June 2017 and September 2020 and there were 115 subjects involved in this research. All patients were diagnosed with adolescent idiopathic scoliosis, Lenke type I/II. Radiographic parameters measured included cervical axis tilt (CAT), T1 tilt, first rib angle (FRA), clavicle angle (CA), radiographic shoulder height (RSH), proximal thoracic curve (PTC), apical vertebra translation of proximal thoracic (AVT of PT), main thoracic curve (MTC), apical vertebra translation of main thoracic (AVT of MT) and coronal balance (CB/C7PL-CSVL). Neck imbalance indexes were obtained and measured following a standardized manner. Intra-class correlation coefficient (ICC) analysis was performed for neck imbalance indexes to determine their intra-observer and inter-observer reliability, and correlation tests were performed for neck imbalance indexes with the radiographic parameters mentioned above. RESULTS Strong intraobserver and interobserver reliability were observed in neck imbalance index (NII) 1 (0.91 and 0.88), neck imbalance index 2 (0.85 and 0.81) and NII 3 (0.82 and 0.80), P < 0.05. Significant correlation was found in cervical axis tilt (R = 0.81 for NII 1, R = 0.77 for NII 2 and R = 0.78 for NII 3), T1 tilt (R = 0.43 for NII 1, R = 0.52 for NII 2 and R = 0.48 for NII 3), first rib angle (R = 0.41 for NII 1, R = 0.48 for NII 2 and R = 0.43 for NII 3), proximal thoracic curve (R = 0.36 for NII 2) and apical vertebra translation of proximal thoracic (R = -0.37 for NII 2 and R = -0.35 for NII 3) with neck imbalance indexes. Neck imbalance index 1 showed the highest correlation with cervical axis tilt (R = 0.81, P < 0.01). CONCLUSIONS Neck imbalance indexes established in our study were in good correlation with cervical axis tilt (CAT), At the meantime, they showed significant correlations with T1 tilt and first rib angle (FRA). Our study provides a practical method for measurement of neck imbalance regarding realistic perspective and makes up for the lack of photographic indexes about neck imbalance.
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Affiliation(s)
- Huawei Zhang
- Department of OrthopaedicsThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina,Key Laboratory of Orthopaedics of Zhejiang ProvinceWenzhouChina,Key Laboratory of Structural Malformations in Children of Zhejiang ProvinceWenzhouChina
| | - Ben Wang
- Department of Orthopaedics SurgeryZhongshan HospitalShanghaiChina
| | - Aimin Wu
- Department of OrthopaedicsThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina,Key Laboratory of Orthopaedics of Zhejiang ProvinceWenzhouChina,Key Laboratory of Structural Malformations in Children of Zhejiang ProvinceWenzhouChina
| | - Chongan Huang
- Department of OrthopaedicsThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina,Key Laboratory of Orthopaedics of Zhejiang ProvinceWenzhouChina,Key Laboratory of Structural Malformations in Children of Zhejiang ProvinceWenzhouChina
| | - Xiangxiang Pan
- Department of OrthopaedicsThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina,Key Laboratory of Orthopaedics of Zhejiang ProvinceWenzhouChina,Key Laboratory of Structural Malformations in Children of Zhejiang ProvinceWenzhouChina
| | - Boda Chen
- Department of OrthopaedicsThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina,Key Laboratory of Orthopaedics of Zhejiang ProvinceWenzhouChina,Key Laboratory of Structural Malformations in Children of Zhejiang ProvinceWenzhouChina
| | - Libin Ni
- Department of OrthopaedicsThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina,Key Laboratory of Orthopaedics of Zhejiang ProvinceWenzhouChina,Key Laboratory of Structural Malformations in Children of Zhejiang ProvinceWenzhouChina
| | - Yifeng Shi
- Department of OrthopaedicsThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina,Key Laboratory of Orthopaedics of Zhejiang ProvinceWenzhouChina,Key Laboratory of Structural Malformations in Children of Zhejiang ProvinceWenzhouChina
| | - Zaher Ali Mohamed Meftah
- Department of OrthopaedicsThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina,Key Laboratory of Orthopaedics of Zhejiang ProvinceWenzhouChina,Key Laboratory of Structural Malformations in Children of Zhejiang ProvinceWenzhouChina
| | - Xiangyang Wang
- Department of OrthopaedicsThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina,Key Laboratory of Orthopaedics of Zhejiang ProvinceWenzhouChina,Key Laboratory of Structural Malformations in Children of Zhejiang ProvinceWenzhouChina
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Sato T, Yonezawa I, Matsumoto H, Otomo N, Suzuki T, Manabe N, Demura S, Watanabe K, Saito T, Nohara A, Kurakawa T, Shimizu T, Uno K, Matsumoto M, Kawakami N. Surgical Predictors for Prevention of Postoperative Shoulder Imbalance in Lenke Type 2A Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2022; 47:E132-E141. [PMID: 34075011 DOI: 10.1097/brs.0000000000004135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter, retrospective cohort study. OBJECTIVE The aim of this study was to investigate the occurrence and surgical predictors of postoperative shoulder imbalance (PSI) in Lenke type 2A adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Although several studies have investigated the factors influencing PSI in Lenke type 2 curves, no studies have analyzed PSI-related factors considering upper instrumented vertebra (UIV) and lumbar modifier type simultaneously. METHODS Patients with Lenke Type 2A AIS treated by spinal fusion were retrospectively identified and their data were extracted from six spine centers in Japan. Inclusion criteria were age between 10 and 20 years at surgery, UIV = T2, major curve 40° to 90°, and follow-up for 24 to 30 months after surgery. We analyzed patient characteristics, surgical characteristics, and preoperative and immediate-postoperative radiographic parameters. We defined patients with lower instrumented vertebra (LIV) equal or proximal to the last touching vertebra (LTV) as selective thoracic fusion (STF-LTV) and patients with LIV distal to the LTV as non-STF-LTV. t Tests, Mann-Whitney U test, χ2 tests, Fisher exact tests, and multivariate logistic regression were used for statistical analyses. RESULTS Among the 99 consecutive patients with a mean follow-up of 25.6 months, PSI was seen in 27 (27.3%) patients immediately after and in 17 (17.2%) patients at 24 to 30 months. The univariate analysis revealed that the significant risk factors of PSI were preoperative radiographical shoulder height, non-STF-LTV, and high main thoracic curve (MTC) correction (immediate-postoperative MTC correction rate: ≥70%), with PSI incidence of 40.0%. The multivariate logistic regression analysis indicated that interaction term of non-STF-LTV and high MTC correction was an independent risk factor for PSI (non-STF-LTV and high MTC correction, odds ratio: 5.167, 95% confidence interval: 1.470-18.159, P = 0.010). CONCLUSION To prevent PSI in Lenke Type 2A AIS patients, surgeons should avoid the combination of non-STF-LTV and high MTC correction in those surgeries with UIV as T2.Level of Evidence: 4.
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Affiliation(s)
- Tatsuya Sato
- Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Ikuho Yonezawa
- Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
- Department of Orthopaedic Surgery, Sangubashi Spine Surgery Hospital, Tokyo, Japan
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Nao Otomo
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Teppei Suzuki
- Department of Orthopaedic Surgery, Kobe Medical Center Kobe, Japan
| | - Nodoka Manabe
- Department of Orthopaedic Surgery, Gunma Spine Center, Takasaki, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Toshiki Saito
- Department of Orthopaedic Surgery, Meijo Hospital, Nagoya, Japan
| | - Ayato Nohara
- Department of Orthopedic Surgery, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Takuto Kurakawa
- Department of Orthopaedic Surgery, Kobe Medical Center Kobe, Japan
| | - Takachika Shimizu
- Department of Orthopaedic Surgery, Gunma Spine Center, Takasaki, Japan
| | - Koki Uno
- Department of Orthopaedic Surgery, Kobe Medical Center Kobe, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
| | - Noriaki Kawakami
- Department of Orthopaedic Surgery, Meijo Hospital, Nagoya, Japan
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Baghdadi S, Cahill P, Anari J, Flynn JM, Upasani V, Bachmann K, Jain A, Baldwin K. Evidence Behind Upper Instrumented Vertebra Selection in Adolescent Idiopathic Scoliosis. JBJS Rev 2021; 9:01874474-202109000-00003. [DOI: 10.2106/jbjs.rvw.20.00255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Reinker KA. CORR Insights®: Is the Combination of Convex Compression for the Proximal Thoracic Curve and Concave Distraction for the Main Thoracic Curve Using Separate-rod Derotation Effective for Correcting Shoulder Balance and Thoracic Kyphosis? Clin Orthop Relat Res 2021; 479:1357-1359. [PMID: 33626025 PMCID: PMC8133099 DOI: 10.1097/corr.0000000000001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/02/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Kent A Reinker
- K. A. Reinker, Clinical Professor (retired), Department of Orthopaedics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Iqbal MO, Samdani AF, Pahys JM, Newton PO, Shah SA, Bastrom TP, Sponseller PD, Miyanji F, Hwang SW. What happens to the unfused upper thoracic curve after posterior spinal fusion for adolescent idiopathic scoliosis? J Neurosurg Pediatr 2021; 27:725-731. [PMID: 33892473 DOI: 10.3171/2020.10.peds20671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/26/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spontaneous lumbar curve correction after selective thoracic fusion in surgery for adolescent idiopathic scoliosis (AIS) is well described. However, only a few articles have described the course of the uninstrumented upper thoracic (UT) curve after fusion, and the majority involve a hybrid construct. In this study, the authors sought to determine the outcomes and associated factors of uninstrumented UT curves in patients with AIS. METHODS The authors retrospectively reviewed a prospectively collected multicenter AIS registry for all consecutive patients with Lenke type 1-4 curves with a 2-year minimum follow-up. UT curves were considered uninstrumented if the upper instrumented vertebra (UIV) did not extend above 1 level from the lower end vertebra of the UT curve. The authors defined progression as > 5°, and divided patients into two cohorts: those with improvement in the UT curve (IMP) and those without improvement in the UT curve (NO IMP). Radiographic, demographic, and Scoliosis Research Society (SRS)-22 survey outcome measures were compared using univariate analysis, and significant factors were compared using a multivariate regression model. RESULTS The study included 450 patients (370 females and 80 males). The UT curve self-corrected in 86% of patients (n = 385), there was no change in 14% (n = 65), and no patients worsened. Preoperatively, patients were similar with respect to Lenke classification (p = 0.44), age (p = 0.31), sex (p = 0.85), and Risser score (p = 0.14). The UT curves in the IMP group self-corrected from 24.7° ± 6.5° to 12.6° ± 5.9°, whereas in the NO IMP group UT curves remained the same, from 20.3° ± 5.8° to 18.5° ± 5.7°. In a multivariate analysis, preoperative main thoracic (MT) curve size (p = 0.004) and MT curve correction (p = 0.001) remained significant predictors of UT curve improvement. Greater correction of the MT curve and larger initial MT curve size were associated with greater likelihood of UT curve improvement. CONCLUSIONS Spontaneous UT curve correction occurred in the majority (86%) of unfused UT curves after MT curve correction in Lenke 1-4 curve types. The magnitude of preoperative MT curve size and postoperative MT curve correction were independent predictors of spontaneous UT curve correction.
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Affiliation(s)
- M Omar Iqbal
- 1Department of Neurosurgery, Rutgers University, Newark, New Jersey
| | - Amer F Samdani
- 2Department of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Pennsylvania
| | - Joshua M Pahys
- 2Department of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Pennsylvania
| | - Peter O Newton
- 3Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California
| | - Suken A Shah
- 4Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Tracey P Bastrom
- 3Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California
| | - Paul D Sponseller
- 5Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland; and
| | - Firoz Miyanji
- 6Department of Orthopaedic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Steven W Hwang
- 2Department of Orthopaedic Surgery and Neurosurgery, Shriners Hospitals for Children-Philadelphia, Pennsylvania
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Etemadifar MR, Andalib A, Mahdinezhad Yazdi M, Farzinnia S. Evaluation of long term outcome of selective fusion in patients with idiopathic scoliosis. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2021; 11:48-53. [PMID: 33824785 PMCID: PMC8012876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Instrumented fusion is the standard treatment in adolescent idiopathic scoliosis (AIS). In patients with both thoracic and lumbar curves there is a trend toward fusing the major curve and keeping the spine mobile with greater function in the future. To evaluate the results of selective fusion in patients with AIS, we aimed to do this research in eligible patients with adolescent idiopathic scoliosis referred to educational hospitals in Isfahan, Iran. METHODS This is a retrospective cross-sectional study which was performed in 2019 in educational hospitals in Isfahan. The study population consisted of 21 patients with idiopathic scoliosis who had been treated with the selective fusion method in 2010-2018. Demographic data of patients including age, sex, and previous medical history and operation results were noted from medical documents of all patients. Cobb's angle measurements and assessments related to complications, Patients' satisfaction and outcome of the surgery were assessed using Patient Outcome Questionnaires developed by Scoliosis Research Society (SRS-22) and 36-Item Short Form Survey (SF-36) questionnaires. RESULTS A total of 21 patients with idiopathic scoliosis were enrolled in the study. The lowest follow-up duration was 2 years and the longest duration was 10 years. We showed that the mean upper curve before interventions were 50.66±7.55 and the mean lower curve before interventions was 35.19±3.86. These amounts improved significantly after surgeries (P<0.001). Evaluation of thoracic apical vertebral translation (AVT) to thoracolumbar or lumbar AVT ratio also showed significant improvements (P<0.001). CONCLUSION Patients undergoing selective fusion benefit from this surgical procedure. The upper and lower curves improved significantly and 85.8% of patients were satisfied with the surgery. Stopping fusion above the L2 in all patients left the lumbar spine mobile which is an important factor in patient satisfaction. We suggest that selective fusion be considered for surgical treatment of some patients with idiopathic scoliosis.
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Affiliation(s)
- Mohammad Reza Etemadifar
- Associate Professor of Spine Surgery, Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Ali Andalib
- Associate Professor of Spine Surgery, Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Masoud Mahdinezhad Yazdi
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Saeed Farzinnia
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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Wang J, Li N, Xia L. A Nomogram to Predict the Occurrence and Development of Postoperative Neck Tilt in Lenke I and II AIS Patients. World Neurosurg 2021; 146:e328-e335. [PMID: 33263289 DOI: 10.1016/j.wneu.2020.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the risk factors and to construct a nomogram for the prediction of postoperative neck tilt (PNT) in patients with Lenke I and II adolescent idiopathic scoliosis (AIS). METHODS A total of 95 patients with Lenke I and II AIS who underwent posterior segmental spinal instrumentation and fusion between the years 2010 and 2018 (with an average 2-year follow-up) at a single institution were retrospectively investigated. The full spine X-rays of patients were measured preoperatively, postoperatively, and at the final follow-up. Variables were compared between the PNT group (n = 33) and the non-PNT group (n = 62), and univariate and multivariate logistic regressions were performed to identify the independent predictors for the occurrence of PNT. The discrimination and calibration of the nomogram were validated by the receiver operating characteristic curve and calibration curve. RESULTS Variables including the preoperative neck tilt, postoperative upper instrumented vertebrae imbalance, postoperative T1 tilt, and decreasing values in the main thoracic curve (ΔMTC) minus decreasing values in the proximal thoracic curve (ΔPTC) (ΔMTC - ΔPTC) were identified as the predictors for the nomogram. The area under the receiver operating characteristic curve was 0.900 (95% confidence interval, 0.857-0.932). Meanwhile, the calibration curve revealed good agreement, and the Hosmer and Lemeshow test determined that the model was well fitted. CONCLUSIONS Preoperative neck tilt, postoperative upper instrumented vertebrae imbalance, postoperative T1 tilt, and ΔMTC-ΔPTC are predictors for the nomogram. The nomogram can provide surgeons with a simple and effective tool to predict the occurrence and development of patients with PNT in Lenke I and II AIS.
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Affiliation(s)
- Jie Wang
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Ning Li
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Lei Xia
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China.
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Wei Chan CY, Chiu CK, Ng YH, Goh SH, Ler XY, Ng SJ, Chian XH, Tan PH, Kwan MK. An analysis of preoperative shoulder and neck balance and surgical outcome in 111 adolescent idiopathic scoliosis patients with two subtypes of Lenke 1 curves. J Neurosurg Spine 2021; 34:37-44. [PMID: 32858516 DOI: 10.3171/2020.5.spine20397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The incidence of postoperative shoulder imbalance following posterior spinal fusion (PSF) is still high in Lenke 1 curves despite following current treatment recommendations for upper instrumented vertebra (UIV) selection. The objective of this retrospective study was to identify differences in preoperative shoulder balance and to report the surgical outcome of two subtypes of Lenke 1 curves (flexible vs stiff) in patients with adolescent idiopathic scoliosis (AIS). METHODS The authors grouped patients' curves as Lenke 1-ve (flexible) when their preoperative proximal thoracic side bending (PTSB) Cobb angle was < 15° and as Lenke 1+ve (stiff) when the PTSB Cobb angle was 15°-24.9°. The authors hypothesized that these two subtypes had distinct preoperative and postoperative shoulder and neck balance following PSF using pedicle screw constructs. RESULTS Fifty patients had Lenke 1 (flexible) curves and 61 had Lenke 1 (stiff) curves. The mean preoperative T1 tilt for patients with Lenke 1 (flexible) was -4.9° ± 5.3°, and for those with Lenke 1 (stiff) curves it was -1.0° ± 5.3° (p < 0.001). Mean cervical axis (CA) was -0.1° ± 3.2° for Lenke 1 (flexible) curves and 2.3° ± 3.5° for Lenke 1 (stiff) curves (p < 0.001). Preoperative radiographic shoulder height (RSH) and clavicle angle (Cla-A) were similar between the two curve subtypes. Following surgery, there were significant differences between the subtypes in terms of T1 tilt (p < 0.001), RSH (p = 0.014), and Cla-A (p = 0.031). Interestingly, 41.0% of patients with a Lenke 1 (stiff) curve had +ve T1 tilt compared to 2.0% in Lenke 1 (flexible) group. Moreover, 26.2% of patients with the Lenke 1 (stiff) curve had +ve RSH compared to 12.0% of those with Lenke 1 (flexible) curves. And, 24.6% of patients with Lenke 1 (stiff) had +ve Cla-A compared to 10.0% of those with Lenke 1 (flexible) curves. CONCLUSIONS Lenke 1 (flexible) and Lenke 1 (stiff) curves had distinct preoperative T1 tilt and CA measurements. Following PSF, the authors noted +ve T1 tilt in 41% of patients with Lenke 1 (stiff) curves versus 2.0% in those with Lenke 1 (flexible) curves. The authors also noted a significant difference in postoperative RSH and Cla-A measurements.
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Conformity and Changes in the Radiological Neck and Shoulder Balance Parameters Throughout 3-Year Follow-up Period: Do They Remain the Same? Spine (Phila Pa 1976) 2020; 45:E319-E328. [PMID: 31593064 DOI: 10.1097/brs.0000000000003275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The primary objective of this study was to assess the conformity of the radiological neck and shoulder balance parameters throughout a follow-up period of more than 2 years. SUMMARY OF BACKGROUND DATA Postoperative shoulder and neck imbalance are undesirable features among Adolescent Idiopathic Scoliosis patients who underwent Posterior Spinal Fusion. There are many clinical and radiological parameters used to assess this clinical outcome. However, we do not know whether these radiological parameters conform throughout the entire follow-up period. METHODS This was a retrospective study done in a single academic institution. Inclusion criteria were patients with scoliosis who underwent posterior instrumented spinal fusion with pedicle screw fixation and attended all scheduled follow-ups for at least 24 months postoperatively. Radiological shoulder parameters were measured from both preoperative antero-posterior and postoperative antero-posterior radiographs. Lateral shoulder parameters were: Radiographic Shoulder Height, Clavicle Angle (Cla-A), Clavicle-Rib Intersection Difference, and Coracoid Height Difference. Medial shoulder and neck parameters were: T1 Tilt and Cervical Axis (CA). RESULTS The radiographs of 50 patients who had surgery done from November 2013 to November 2015 were analyzed. Mean age of this cohort was 16.3 ± 7.0 years. There were 38 (76%) female patients and 12 (24%) male patients. Mean final follow-up was 38.6 ± 5.8 months. When conformity assessment of the radiological parameter using the interclass coefficient correlation was done, we found that all parameters had significant correlation (P < 0.05). T1 tilt (0.78) had good reliability, CA (0.47), Clavicle-Rib Intersection Difference (0.43), and Coracoid Height Difference (0.40) had moderate reliability and Radiographic Shoulder Height (0.22) and Cla-A (0.13) had poor reliability. CONCLUSION All the radiological shoulder and neck balance parameters studied were conformed and suitable to be used to assess the patient postoperatively. Amongst these radiological parameters, T1 tilt followed by CA recorded to be the most reliable parameters over time. LEVEL OF EVIDENCE 4.
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The Reliability of Intraoperative Crossbar Technique in Determining the Upper Instrumented Vertebra (UIV) Tilt Angle for Adolescent Idiopathic Scoliosis (AIS) Undergoing Posterior Spinal Fusion. Clin Spine Surg 2019; 32:256-262. [PMID: 30640749 DOI: 10.1097/bsd.0000000000000769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE This study looked into whether crossbar can reliably measure Upper Instrumend Vertebra (UIV) tilt angle intraoperatively and accurately predict the UIV tilt angle postoperatively and at final follow-up. SUMMARY OF BACKGROUND DATA Postoperative shoulder imbalance is a common cause of poor cosmetic appearance leading to patient dissatisfaction. There were no reports describing the technique or method in measuring the UIV tilt angle intraoperatively. Therefore, this study was designed to look into the reliability and accuracy of the usage of intraoperative crossbar in measuring the UIV tilt angle intraoperatively. METHODS Lenke 1 and 2 Adolescent Idiopathic Scoliosis patients who underwent instrumented Posterior Spinal Fusion using pedicle screw constructs with minimum follow-up of 24 months were recruited for this study. After surgical correction, intraoperative UIV tilt angle was measured using a crossbar. Immediate postoperative and final follow up UIV tilt angle was measured on the standing anteroposterior radiographs. RESULTS A total of 100 patients were included into this study. The reliability of the intraoperative crossbar to measure the optimal UIV tilt angle intraoperatively was determined by repeated measurements by assessors and measurement by different assessors. We found that the intra observer and inter observer reliability was very good with intraclass correlation coefficient values of >0.9. The accuracy of the intraoperative crossbar to measure the optimal UIV tilt angle intraoperatively was determined by comparing this measurement with the postoperative UIV tilt angle. We found that there was no significant difference (P>0.05) between intraoperative, immediate postoperative, and follow-up UIV tilt angle. CONCLUSIONS The crossbar can be used to measure the intraoperative UIV tilt angle consistently and was able to predict the postoperative UIV tilt angle. It was a cheap, simple, reliable, and accurate instrument to measure the intraoperative UIV tilt angle.
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How Common Is Medial and Lateral Shoulder Discordance in Lenke 1 and 2 Curves?: A Preoperative Analysis of Medial and Lateral Shoulder Balance Among 151 Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients. Spine (Phila Pa 1976) 2019; 44:E480-E486. [PMID: 30299417 DOI: 10.1097/brs.0000000000002890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of prospectively collected data. OBJECTIVE To analyze the incidence and the patterns of medial and lateral shoulder discordance among Lenke 1 and 2 patients. SUMMARY OF BACKGROUND DATA Postoperative shoulder imbalance (PSI) is still common in Lenke 1 and 2 adolescent idiopathic scoliosis (AIS). This could be due to presence of medial dan lateral shoulder discordance. METHODS One hundred fifty-one Lenke 1 and 2 AIS patients were recruited. Lenke 1 curves were subclassified into Lenke 1-ve (flexible) (proximal thoracic side bending [PTSB] Cobb angle <15°) and 1+ve curves (stiff) (PTSB Cobb angle between 15° and 24.9°). T1 tilt represented "medial shoulder balance" and radiological shoulder height (RSH) represented "lateral shoulder balance." We categorized patients into three concordant shoulder pattern types (medial balanced/lateral balanced [MBLB], medial imbalanced+ve/lateral imbalanced+ve (MI+ve/LI+ve), medial imbalanced-ve/lateral Imbalanced-ve (MI-ve/LI-ve), and six discordant shoulder pattern types. RESULTS The mean age was 16.2 ± 5.7 years. Eighty-one patients (53.6%) had concordant pattern and 70 patients (46.4%) had discordant pattern. Lateral shoulder imbalance was noted in 35.1% of patients and medial shoulder imbalance in 43.7% of patients. In Lenke 1-ve curves, 35 patients (68.6%) had concordant shoulder imbalance with medial imbalanced-ve/lateral imbalanced-ve (MI-ve/LI-ve) being the commonest pattern (68.6%). In Lenke 1+ve curves, 33 patients (55.0%) had concordant shoulder pattern with medial balanced/lateral balanced (MB/LB) being the commonest type (57.6%). In Lenke 2 AIS, 27 patients (67.5%) had discordant pattern with medial imbalanced+ve/lateral balanced (MI+ve/LB) being the commonest pattern (44.4%) (P value = 0.002). CONCLUSION 46.4% Lenke 1 and 2 AIS patients had shoulder discordant pattern. This was more prevalent in Lenke 2 curves (67.5%). In Lenke 1-ve (flexible) curves, MI-ve/LI-ve pattern was the commonest pattern. In Lenke 1+ve curves (stiff), there were almost equal number of concordant and discordant shoulder pattern. In Lenke 2 patients, the most common pattern was MI+ve/LB. LEVEL OF EVIDENCE 4.
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Tang Y, Xu X, Zhu F, Chen C, Wang F, Lu M, Huang X. Incidence and Risk Factors of Cervical Kyphosis in Patients with Adolescent Idiopathic Scoliosis. World Neurosurg 2019; 127:e788-e792. [PMID: 30951919 DOI: 10.1016/j.wneu.2019.03.264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cervical kyphosis (CK) has been reported in patients with adolescent idiopathic scoliosis (AIS). The report about the incidence of CK between patients with AIS and normal populations was little. Patients included in previous studies often required scoliosis surgery (Cobb angle ≥40°), which does not represent all patients with AIS. The aims of this study were to compare incidence of CK between patients with AIS (Cobb angle >10°) and an age-matched normal population and to identify risk factors related to CK, especially coronal parameters that have rarely been studied in current literature. METHODS Patients with AIS (n = 112) and asymptomatic subjects from the general population (control group; n = 40) were retrospectively analyzed. Radiographic parameters of coronal and sagittal plane were measured on full-length spine x-rays. Patients with AIS were divided into 2 groups based on cervical lordosis angle: cervical lordosis and CK. RESULTS CK was observed in 14 of 40 (35%) subjects in the control group and 68 of 112 (60.7%) patients with AIS. Several parameters were related to CK, including major curve, proximal thoracic, and main thoracic Cobb angle; proximal thoracic kyphosis angle; main thoracic kyphosis angle; T1 slope; sagittal vertical axis; vertical distance between C7 plumb line and center sacral vertical line; apical vertebral translation; T1 coronal tilt; and lumbar pelvic relationship. Logistic regression identified main thoracic Cobb angle, main thoracic kyphosis angle, sagittal vertical axis, lumbar pelvic relationship, and apical vertebral translation as independent risk factors of CK. CONCLUSIONS Incidence of CK increases in patients with AIS relative to normal subjects. Coronal parameters of the spine could influence cervical sagittal alignment.
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Affiliation(s)
- Yong Tang
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China.
| | - Xingping Xu
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
| | - Feng Zhu
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
| | - Changwei Chen
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
| | - Fusheng Wang
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
| | - Min Lu
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
| | - Xing Huang
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
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Upper Instrumented Vertebrae (UIV) Tilt Angle Is an Important Postoperative Radiological Parameter That Correlates With Postoperative Neck and Medial Shoulder Imbalance. Spine (Phila Pa 1976) 2018; 43:E1143-E1151. [PMID: 29557927 DOI: 10.1097/brs.0000000000002645] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To investigate the association between postoperative upper instrumented vertebrae (UIV) tilt angle with postoperative medial shoulder and neck imbalance. SUMMARY OF BACKGROUND DATA Studies had found that current recommendations for UIV selection were not predictive of good postoperative shoulder balance. METHODS A total of 98 patients with adolescent idiopathic scoliosis with Lenke 1/2 curves who underwent posterior spinal fusion between 2013 and 2014 with minimum follow-up of 2 years were recruited. Radiological parameters: UIV tilt angle, T1 tilt, cervical axis, and clavicle angle were measured preoperatively, postoperatively, and at final follow-up. RESULTS Mean age was 16.2 ± 6.2 years. Mean follow-up was 37.9 ± 6.5 months. There were 73.5% Lenke 1 and 26.5% Lenke 2 curves. Significant factors affecting postoperative T1 Tilt were postoperative UIV tilt angle, preoperative T1 tilt, and preoperative UIV tilt angle. Postoperative UIV tilt angle and preoperative cervical axis were significant factors affecting cervical axis at final follow-up. UIV level was not significant independent factor that affected postoperative T1 tilt and cervical axis. There was strong correlation between postoperative UIV tilt angle and T1 tilt for the whole cohort (P < 0.001), when UIV was at T2 (P < 0.001), T3 (P < 0.001), and T4 (P < 0.001). Postoperative UIV tilt angle also had significant correlation with cervical axis when UIV was at T2 (P = 0.021) and T3 (P = 0.009). CONCLUSION Postoperative UIV tilt angle was an independent factor, which had significant correlation with postoperative T1 tilt and cervical axis measurement. There was strong correlation between postoperative UIV tilt angle and T1 tilt for the whole cohort, when UIV was at T3 and T4. There was very strong correlation between postoperative UIV tilt angle and T1 tilt when UIV was at T2. There was also moderate and significant correlation between postoperative UIV tilt angle and cervical axis for the whole cohort. LEVEL OF EVIDENCE 2.
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Chiu CK, Bashir ES, Chan CYW, Kwan MK. Cervical Supine Side-Bending versus Cervical Supine Traction Radiographs: Which Is Better in Predicting Proximal Thoracic Flexibility for Lenke 1 and 2 Adolescent Idiopathic Scoliosis? Asian Spine J 2018; 12:669-677. [PMID: 30060375 PMCID: PMC6068410 DOI: 10.31616/asj.2018.12.4.669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/17/2017] [Indexed: 11/23/2022] Open
Abstract
Study Design Prospective cohort study. Purpose This study compared cervical supine side-bending (CSSB) and cervical supine traction (CST) radiographs to assess the flexibility and predict the correctability of the proximal thoracic (PT) curve for patients with adolescent idiopathic scoliosis (AIS) classified as Lenke 1 and 2. Overview of Literature Knowledge of the flexibility of the PT curve is crucial in the management of patients with AIS. There are no reports comparing CSSB and CST radiographs to assess this parameter. Methods Thirty patients with Lenke 1 and 2 AIS scheduled for posterior spinal fusion surgery were recruited. A standing whole spine radiography and physician-supervised CSSB and CST radiographies were performed. Patient demographic and radiological parameters were recorded, including age, gender, weight, height, body mass index, PT angle, main thoracic angle, CSSB PT angle, CST PT angle, and postoperative PT angle. From the data collected, the curve flexibility and curve correction index were calculated and compared. Results CSSB had a significantly (p <0.05) smaller PT angle (16.6°±10.4°) in comparison to CST (23.7°±10.7°). CSSB had significantly (p <0.05) greater flexibility (44.2%±19.7%) in comparison to CST (19.5%±18.1%). The CSSB correction index (1.2±0.9) was significantly closer to 1 in comparison to the CST correction index (4.4±5.3). There was no difference (p =0.72) between the CSSB PT angle (16.6°±10.4°) and the postoperative PT angle (16.1°±7.5°). However, the CST PT angle (23.7°±10.7°) was significantly (p <0.05) larger than the postoperative PT angle (16.1°±7.5°). Conclusions CSSB radiographs were better for demonstrating PT flexibility and more accurately predicted correctability in comparison to the CST radiographs.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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