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Correction of hypokyphosis in thoracic adolescent idiopathic scoliosis using sublaminar bands: a 3D multicenter study

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Abstract

Introduction

The comparison of implants and correction methods remain controversial in AIS. Excellent frontal and axial correction rates have been reported with all-screw constructs, but at the expense of sagittal alignment, which has a tendency to flatten postoperatively. Posteromedial translation using hybrid constructs seems to preserve and improve thoracic kyphosis (TK), but no series exist to date with a significant number of hypokyphotic patients. In addition, the measures of TK in 2D are often wrong in severe AIS due to axial rotation. The goals of this study were therefore to analyze the 3D radiological outcomes of a group of hypokyphotic AIS patients operated with sublaminar bands.

Methods

35 consecutive AIS hypokyphotic patients (T4T12 <15°) operated in three centers were included, with a minimum 2-year follow-up. The surgical technique was similar in all centers, associating lumbar pedicle screws and thoracic sublaminar bands. Posteromedial translation was the main correction technique, and no patient underwent prior anterior release. 3D spinal reconstructions were performed preoperatively, postoperatively and at the latest follow-up by an independent observer using SterEOS (EOS imaging, Paris, France), and 2D and 3D measurements were compared. In addition, a new 3D parameter [sagittal shift of the apical vertebra (SSAV)], reflecting the translation of the apical vertebra of the main curve in the patient sagittal plane, was described and reported.

Results

The age of the cohort was 16 years and the number of sublaminar bands used for correction averaged 6 (±1.5). T1T12 and T4T12 sagittal Cobb angles appeared to be overestimated on 2D postoperatively (3°, p = 0.002 and 4°, p < 0.001, respectively). Hence, only 3D measurements were kept for the quantitative analysis of the postoperative correction. T4T12 TK significantly increased after surgery (average 8° ± 7°, p < 0.001), but 11 patients (31.4%) remained hypokyphotic. Seven out of the eight patients (87.5%) who presented a thoracic lordosis (i.e., T4T12 <0°) preoperatively were corrected after surgery (mean gain 16° ± 4°). A posterior shift (positive SSAV) of the apical vertebra was reported in 24 patients (68.6%). In this subgroup, the mean SSAV was +2 cm (±1). Good correlation was found between the SSAV and the postoperative change in 3D T4T12 kyphosis (r = 0.62).

Conclusion

Measures in 2D tend to overestimate sagittal alignment and are not sufficient to evaluate postoperative correction. SSAV is a new 3D parameter reflecting the TK change that needs to be further investigated and used in the future. This series confirms that sublaminar bands should be considered in hypokyphotic patients, since thoracic sagittal alignment was restored in 68.6% of the cases.

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References

  1. Winter RB, Lonstein JE, Denis F (2007) How much correction is enough? Spine (Phila Pa 1976) 32:2641–2643

    Article  Google Scholar 

  2. Pankowski R, Roclawski M, Ceynowa M, Mikulicz M, Mazurek T, Kloc W (2016) Direct vertebral rotation versus single concave rod rotation: low-dose intraoperative computed tomography evaluation of spine derotation in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 41:864–871

    Article  Google Scholar 

  3. Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, Hyman JE, Roye DP Jr (2007) Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976) 32:448–452

    Article  Google Scholar 

  4. Hwang SW, Samdani AF, Tantorski M, Cahill P, Nydick J, Fine A, Betz RR, Antonacci MD (2011) Cervical sagittal plane decompensation after surgery for adolescent idiopathic scoliosis: an effect imparted by postoperative thoracic hypokyphosis. J Neurosurg Spine 15:491–496

    Article  PubMed  Google Scholar 

  5. Martin CT, Pugely AJ, Gao Y, Mendoza-Lattes SA, Ilgenfritz RM, Callaghan JJ, Weinstein SL (2014) Increasing hospital charges for adolescent idiopathic scoliosis in the United States. Spine (Phila Pa 1976) 39:1676–1682

    Article  Google Scholar 

  6. Newton PO, Yaszay B, Upasani VV, Pawelek JB, Bastrom TP, Lenke LG, Lowe T, Crawford A, Betz R, Lonner B, Harms Study Group (2010) Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:1365–1370

    Article  Google Scholar 

  7. Yaszay B, Bastrom TP, Bartley CE, Parent S, Newton PO (2016) The effects of the three-dimensional deformity of adolescent idiopathic scoliosis on pulmonary function. Eur Spine J 26(6):1658–1664. doi:10.1007/s00586-016-4694-y

    Article  PubMed  Google Scholar 

  8. Johnston CE, Richards BS, Sucato DJ, Bridwell KH, Lenke LG, Erickson M, Spinal Deformity Study Group (2011) Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 36(14):1096–1102

    Article  Google Scholar 

  9. Ran B, Fan Y, Yuan F, Guo K, Zhu X (2016) Pulmonary function changes and its influencing factors after preoperative brace treatment in patients with adolescent idiopathic scoliosis: a retrospective case-control study. Medicine (Baltimore) 95(43):e5088

    Article  Google Scholar 

  10. Newton PO, Fujimori T, Doan J, Reighard FG, Bastrom TP, Misaghi A (2015) Defining the “Three-Dimensional Sagittal Plane” in thoracic adolescent idiopathic scoliosis. J Bone Jt Surg Am 97:1694–1701

    Article  Google Scholar 

  11. Lamerain M, Bachy M, Delpont M, Kabbaj R, Mary P, Vialle R (2014) CoCr rods provide better frontal correction of adolescent idiopathic scoliosis treated by all-pedicle screw fixation. Eur Spine J 23:1190–1196

    Article  PubMed  Google Scholar 

  12. Sudo H, Abe Y, Kokabu T, Ito M, Abumi K, Ito YM, Iwasaki N (2016) Correlation analysis between change in thoracic kyphosis and multilevel facetectomy and screw density in main thoracic adolescent idiopathic scoliosis surgery. Spine J 16:S1529–S9930

    Google Scholar 

  13. Ferrero E, Pesenti S, Blondel B, Jouve JL, Mazda K, Ilharreborde B (2014) Role of thoracoscopy for the sagittal correction of hypokyphotic adolescent idiopathic scoliosis patients. Eur Spine J 23:2635–2642

    Article  CAS  PubMed  Google Scholar 

  14. Ilharreborde B, Sebag G, Skalli W, Mazda K (2013) Adolescent idiopathic scoliosis treated with posteromedial translation: radiologic evaluation with a 3D low-dose system. Eur Spine J 22:2382–2391

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ilharreborde B, Steffen JS, Nectoux E, Vital JM, Mazda K, Skalli W, Obeid I (2011) Angle measurement reproducibility using EOS three-dimensional reconstructions in adolescent idiopathic scoliosis treated by posterior instrumentation. Spine (Phila Pa 1976) 36:E1306–E1313

    Article  Google Scholar 

  16. Vidal C, Ilharreborde B, Azoulay R, Sebag G, Mazda K (2013) Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis. Eur Spine J 22:1362–1367

    Article  PubMed  PubMed Central  Google Scholar 

  17. De Kleuver M, Lewis SJ, Germscheid NM, Kamper SJ, Alanay A, Berven SH, Cheung KM, Ito M, Lenke LG, Polly DW, Qiu Y, van Tulder M, Shaffrey C (2014) Optimal surgical care for adolescent idiopathic scoliosis: an international consensus. Eur Spine J 23:2603–2618

    Article  PubMed  Google Scholar 

  18. Quan GM, Gibson MJ (2010) Correction of main thoracic adolescent idiopathic scoliosis using pedicle screw instrumentation: does higher implant density improve correction? Spine (Phila Pa 1976) 35:562–567

    Article  Google Scholar 

  19. Ilharreborde B, Vidal C, Skalli W, Mazda K (2013) Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis treated by posteromedial translation. Eur Spine J 22:330–337

    Article  PubMed  Google Scholar 

  20. Ilharreborde B, Dubousset J, Le Huec JC (2014) Use of EOS imaging for the assessment of scoliosis deformities: application to postoperative 3D quantitative analysis of the trunk. Eur Spine J 23(Suppl 4):S397–S405

    PubMed  Google Scholar 

  21. Charles YP, Sfeir G, Matter-Parrat V, Sauleau EA, Steib JP (2015) Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending. Spine (Phila Pa 1976) 40:E419–E427

    Article  Google Scholar 

  22. Watanabe K, Nakamura T, Iwanami A, Hosogane N, Tsuji T, Ishii K, Nakamura M, Toyama Y, Chiba K, Matsumoto M (2012) Vertebral derotation in adolescent idiopathic scoliosis causes hypokyphosis of the thoracic spine. BMC Musculoskelet Disord 12(13):99

    Article  Google Scholar 

  23. Fletcher ND, Hopkins J, McClung A, Browne R, Sucato DJ (2012) Residual thoracic hypokyphosis after posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis: risk factors and clinical ramifications. Spine (Phila Pa 1976) 37:200–206

    Article  Google Scholar 

  24. Clement JL, Geoffray A, Yagoubi F, Chau E, Solla F, Oborocianu I, Rampal V (2013) Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis. Eur Spine J 22:2414–2420

    Article  PubMed  PubMed Central  Google Scholar 

  25. ICRP, Khong PL, Ringertz H, Donoghue V, Frush D, Rehani M, Appelgate K, Sanchez R (2013) ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP 42(2):1–63

    Article  Google Scholar 

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Authors and Affiliations

  1. Pediatric Orthopaedic Department, CHU Robert Debré, AP-HP, Paris Diderot University, Paris, France

    Brice Ilharreborde, Emmanuelle Ferrero & Keyvan Mazda

  2. Pediatric Orthopaedic Department, Timone Children Hospital, Aix-Marseille University, Marseille, France

    Sébastien Pesenti & Jean-Luc Jouve

  3. Pediatric Orthopaedic Department, Children Hospital, CHU Toulouse, France

    Franck Accadbled & Jérôme Sales De Gauzy

Authors
  1. Brice Ilharreborde
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  2. Sébastien Pesenti
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  3. Emmanuelle Ferrero
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  4. Franck Accadbled
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  5. Jean-Luc Jouve
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  6. Jérôme Sales De Gauzy
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  7. Keyvan Mazda
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Correspondence to Brice Ilharreborde.

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The authors declare that they have no competing interests.

Funding

Brice Ilharreborde, Keyvan Mazda and Jerôme Sales de Gauzy have received consultancy fees (unrelated to this study) from Implanet (Implanet, Bordeaux, France).

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Ilharreborde, B., Pesenti, S., Ferrero, E. et al. Correction of hypokyphosis in thoracic adolescent idiopathic scoliosis using sublaminar bands: a 3D multicenter study. Eur Spine J 27, 350–357 (2018). https://doi.org/10.1007/s00586-017-5166-8

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  • DOI: https://doi.org/10.1007/s00586-017-5166-8

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