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Progressive coronal caudal curve after corrective osteotomies for congenital cervicothoracic scoliosis: incidence and predictors

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Abstract

Objective

Postoperative progressive coronal caudal curve (PCC) was characterized by a postoperative de novo caudal S-curve ≥ 20° following congenital cervicothoracic scoliosis (CTS) corrective osteotomies, and at least 20° greater than the preoperative measurement, while the incidence was uncertain and the pathogenesis was equivocal. The objective of this study was to investigate the morbidity and potential factors contributing to PCC following CTS surgery.

Methods

This study reviewed 72 CTS patients between 2005 and 2021. Patients were categorized into two groups according to the absence or presence of PCC at last follow-up, namely the nonprogressive curve group (NPC-group) and the progressive curve group (PC-group). Demographics, radiographic data and the Scoliosis Research Society-22 (SRS-22) questionnaire results were reviewed. Multivariate linear regression analyses were utilized to determine possible predictors for PCC.

Results

PCC was observed in 11 (15%) of the total 72 patients. Compared with the NPC-group, the PC-group exhibited greater postoperative residual local curve (24.0 ± 9.7° vs. 9.1 ± 4.4°, P < 0.001), upper instrumented vertebra (UIV) tilt (16.9 ± 7.4° vs. 6.2 ± 3.7°, P < 0.001), T1 tilt (14.3 ± 9.4° vs. 6.6 ± 3.9°, P = 0.022) and neck tilt (10.1 ± 6.7° vs. 3.7 ± 2.5, P = 0.009). The multivariable linear regression demonstrated that the larger postoperative UIV tilt, residual local curve and neck tilt were associated with PCC. In addition, patients with PCC showed lower SRS-22 scores in terms of pain, mental health, self-image and satisfaction (P < 0.05).

Conclusions

The morbidity of PCC was 15% in CTS patients who underwent corrective osteotomies. Greater residual local curve, postoperative UIV tilt and neck tilt were identified as predictors for PCC.

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Acknowledgements

This study was supported by Hunan Provincial Key Research and Development Program (2021SK2002).

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Author notes

  1. Ziqun Liu and Bin Jiang contributed equally to this work.

Authors and Affiliations

  1. Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China

    Ziqun Liu, Bin Jiang, Yawei Li, Yuliang Dai, Lei Li, Yupeng Zhang, Zhenzhong Zheng & Bing Wang

  2. Anhua County People’s Hospital of Yiyang, Hunan, People’s Republic of China

    Yifang Jiang

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  1. Ziqun Liu
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Correspondence to Bing Wang.

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This study was approved by the Second Xiangya Hospital Ethics Committee (No. 2021600).

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Liu, Z., Jiang, B., Jiang, Y. et al. Progressive coronal caudal curve after corrective osteotomies for congenital cervicothoracic scoliosis: incidence and predictors. Eur Spine J 33, 1675–1682 (2024). https://doi.org/10.1007/s00586-024-08189-7

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