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Surgical increase in thoracic kyphosis predicts increase of cervical lordosis after thoracic fusion for adolescent idiopathic scoliosis

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Abstract

Purpose

The modification of cervical lordosis (CL) after adolescent idiopathic scoliosis (AIS) surgery is influenced by the correction of thoracic hypokyphosis. The quantification of the increase of CL as a function of the increase of thoracic kyphosis (TK) has never been calculated.

Methods

A total of 92 consecutive AIS patients who underwent a posterior thoracic selective fusion, corrected by simultaneous translation on 2 rods technique, with minimum 24-month follow-up, were analyzed from a prospective database. We evaluated global sagittal kyphosis and lordosis. CL was divided by the horizontal line in proximal (PCL) and distal cervical lordosis (DCL), likewise TK in proximal (PTK) and distal TK (DTK), and lumbar lordosis (LL) in proximal (PLL) and distal LL (DLL).

Results

The mean TK gain was 16°, 14° and 28° in the whole cohort, normokyphosis group and hypokyphosis group, respectively. The mean DCL gain was, respectively, 9°, 7° and 20° and the mean CL gain 8°, 5° and 21°. There was a strong correlation between TK gain and CL gain (coefficient = 0.86) and between TK gain and DCL gain (coefficient = 0.74). The regression equation was defined as DCLgain = − 3 + 0.75 × TKgain (p < 0.0001) corresponding on average to 60% of the TK gain.

Conclusion

60% of the TK gain was transferred to DCL gain. Correlations reflect the geometrical equivalence between PTK and DCL. The use of sagittal global measurements shows that DCL is equivalent to PTK and can be expressed as a function of pelvic parameters (DCL = PT + LL-PI). DCL must be considered to optimize the postoperative sagittal alignment of the spine.

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References

  1. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Ferrantelli JR, Haas JW, Holland B (2004) Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine 29:2485–2492

    Article  Google Scholar 

  2. McAviney J, Schulz D, Bock R, Harrison DE, Holland B (2005) Determining the relationship between cervical lordosis and neck complaints. J Manip Physiol Ther 28:187–193. https://doi.org/10.1016/j.jmpt.2005.02.015

    Article  Google Scholar 

  3. Scheer JK, Tang JA, Smith JS, Acosta FL, Protopsaltis TS, Blondel B, Bess S, Shaffrey CI, Deviren V, Lafage V, Schwab F, Ames CP, International Spine Study Group (2013) Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 19:141–159. https://doi.org/10.3171/2013.4.SPINE12838

    Article  PubMed  Google Scholar 

  4. Hilibrand AS, Tannenbaum DA, Graziano GP, Loder RT, Hensinger RN (1995) The sagittal alignment of the cervical spine in adolescent idiopathic scoliosis. J Pediatr Orthop 15:627–632

    Article  CAS  Google Scholar 

  5. Akbar M, Almansour H, Lafage R, Diebo BG, Wiedenhöfer B, Schwab F, Lafage V, Pepke W (2018) Sagittal alignment of the cervical spine in the setting of adolescent idiopathic scoliosis. J Neurosurg Spine 24:506. https://doi.org/10.3171/2018.3.SPINE171263

    Article  Google Scholar 

  6. Hiyama A, Sakai D, Watanabe M, Katoh H, Sato M, Mochida J (2016) Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis: a comparative study of 42 adolescents with idiopathic scoliosis and 24 normal adolescents. Eur Spine J 25:3226–3233. https://doi.org/10.1007/s00586-016-4701-3

    Article  PubMed  Google Scholar 

  7. Canavese F, Turcot K, De Rosa V, De Coulon G, Kaelin A (2011) Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Eur Spine J 20:1141–1148. https://doi.org/10.1007/s00586-011-1837-z

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yu M, Silvestre C, Mouton T, Rachkidi R, Zeng L, Roussouly P (2013) Analysis of the cervical spine sagittal alignment in young idiopathic scoliosis: a morphological classification of 120 cases. Eur Spine J 22:2372–2381. https://doi.org/10.1007/s00586-013-2753-1

    Article  PubMed  PubMed Central  Google Scholar 

  9. Guo G-M, Li J, Diao Q-X, Zhu T-H, Song Z-X, Guo Y-Y, Gao Y-Z (2018) Cervical lordosis in asymptomatic individuals: a meta-analysis. J Orthop Surg Res 13:147–154. https://doi.org/10.1186/s13018-018-0854-6

    Article  PubMed  PubMed Central  Google Scholar 

  10. Moskowitz A, Moe JH, Winter RB, Binner H (1980) Long-term follow-up of scoliosis fusion. J Bone Joint Surg Am 62:364–376

    Article  CAS  Google Scholar 

  11. Protopsaltis TS, Scheer JK, Terran JS, Smith JS, Hamilton DK, Kim HJ et al (2015) How the neck affects the back: changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up. J Neurosurg Spine 23:153–158. https://doi.org/10.3171/2014.11.SPINE1441

    Article  PubMed  Google Scholar 

  12. Youn MS, Shin JK, Goh TS, Kang SS, Jeon WK, Lee JS (2015) Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis. Eur Spine J 25:3114–3119. https://doi.org/10.1007/s00586-016-4488-2

    Article  Google Scholar 

  13. Sabah Y, Clément JL, Solla F, Rosello O, Rampal V (2018) Cobalt-chrome and titanium alloy rods provide similar coronal and sagittal correction in adolescent idiopathic scoliosis. Orthopaed Traumatol: Surg Res 104:1073–1077. https://doi.org/10.1016/j.otsr.2018.07.018

    Article  Google Scholar 

  14. 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. https://doi.org/10.1007/s00586-012-2493-7

    Article  PubMed  Google Scholar 

  15. Charles YP, Sfeir G, Matter-Parrat V, Sauleau EA, Steib J-P (2015) Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending. Spine 40:E419–E427. https://doi.org/10.1097/BRS.0000000000000767

    Article  PubMed  Google Scholar 

  16. Hayashi K, Toyoda H, Terai H, Suzuki A, Hoshino M, Tamai K et al (2017) Cervical lordotic alignment following posterior spinal fusion for adolescent idiopathic scoliosis: reciprocal changes and risk factors for malalignment. J Neurosurg Pediatr. https://doi.org/10.3171/2016.9.PEDS16298

    Article  PubMed  Google Scholar 

  17. Yan P, Zhang Y, Liu S, Shu S, Liu Z, Zhu Z et al (2018) Sagittal Profile Response of cervical spine after posterior correction in thoracic and lumbar adolescent idiopathic scoliosis: correlation with thoracic kyphosis? World Neurosurg. 120:e333-341. https://doi.org/10.1016/j.wneu.2018.08.071

    Article  PubMed  Google Scholar 

  18. Luo S-G, Zhong Z-M, Zhu S-Y, Chen J-T (2018) The change of cervical sagittal alignment after surgery for adolescent idiopathic scoliosis. Clin Neurol Neurosurg 171:21–25. https://doi.org/10.1016/j.clineuro.2018.04.01

    Article  PubMed  Google Scholar 

  19. Clément J-L, Pelletier Y, Solla F, Rampal V (2019) Surgical increase in thoracic kyphosis increases unfused lumbar lordosis in selective fusion for thoracic adolescent idiopathic scoliosis. Eur Spine J 28:581–589. https://doi.org/10.1007/s00586-018-5740-8

    Article  PubMed  Google Scholar 

  20. Clément JL, Chau E, Vallade MJ, Geoffray A (2011) Simultaneous translation on two rods is an effective method for correction of hypokyphosis in AIS: radiographic results of 24 hypokyphotic thoracic scoliosis with 2 years minimum follow-up. Eur Spine J 20:1149–1156. https://doi.org/10.1007/s00586-011-1779-5

    Article  PubMed  PubMed Central  Google Scholar 

  21. Maillot C, Ferrero E, Fort D, Heyberger C, Le Huec C (2015) Reproducibility and repeatability of a new computerized software for sagittal spinopelvic and scoliosis curvature radiologic measurements: Keops. Eur Spine J 24:1574–1581. https://doi.org/10.1007/s00586-015-3817-1

    Article  CAS  PubMed  Google Scholar 

  22. Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. Spinal Disord Tech 18:40–47

    Article  Google Scholar 

  23. Solla F, Tran A, Bertoncelli D, Musoff C, Bertoncelli CM (2018) Why a P-Value is Not Enough. Clin Spine Surg. 31:385–388. https://doi.org/10.1097/BSD.0000000000000695

    Article  PubMed  Google Scholar 

  24. Clément J-L, Solla F, Amorese V, Oborocianu I, Rosello O, Rampal V (2020) Lumbopelvic parameters can be used to predict thoracic kyphosis in adolescents. Eur Spine J 29:2281–2286. https://doi.org/10.1007/s00586-020-06373-z

    Article  PubMed  Google Scholar 

  25. Le Huec JC, Demezon H, Aunoble S (2015) Sagittal parameters of global cervical balance using EOS imaging: normative values from a prospective cohort of asymptomatic volunteers. Eur Spine J 24:63–71. https://doi.org/10.1007/s00586-014-3632-0

    Article  PubMed  Google Scholar 

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Acknowledgments

Jean-Luc Clément has received consultancy fees and financial support for attending symposia (unrelated to this study) from Médicrea. Federico Solla has received financial support for attending symposia (unrelated to this study) from Médicrea. (Médicréa International, Rillieux La Pape, France).

Funding

This work was not funded.

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Authors and Affiliations

  1. Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux Pédiatriques de Nice CHU Lenval, 57 Avenue de la Californie, Nice, France

    Jean-Luc Clement, Ludovic Le Goff, Ioana Oborocianu, Olivier Rosello, Carlo Bertoncelli, Federico Solla & Virginie Rampal

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  1. Jean-Luc Clement
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  2. Ludovic Le Goff
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  3. Ioana Oborocianu
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  4. Olivier Rosello
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  5. Carlo Bertoncelli
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  6. Federico Solla
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  7. Virginie Rampal
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Ludovic Le Goff, Jean-Luc Clément and Federico Solla. The first draft of the manuscript was written by Ludovic Le Goff and the final manuscript by Jean-Luc Clément. All authors read and approved the final manuscript.

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Correspondence to Jean-Luc Clement.

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The authors declare that they have no conflict of interest.

Ethical and approval

All procedures were in accordance with the 1964 Helsinki Declaration and its later amendments. This study has been approved by the authors’ Institutional Review Board: CPP (committee for the protection of persons) with number 2017728v0.

Informed consent

Informed written consent by both parents and patients has been obtained. We followed the STROBE statement (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational studies.

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Clement, JL., Le Goff, L., Oborocianu, I. et al. Surgical increase in thoracic kyphosis predicts increase of cervical lordosis after thoracic fusion for adolescent idiopathic scoliosis. Eur Spine J 30, 3550–3556 (2021). https://doi.org/10.1007/s00586-021-06904-2

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  • DOI: https://doi.org/10.1007/s00586-021-06904-2

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