Analysis of risk factors for loss of lumbar lordosis in patients who had surgical treatment with segmental instrumentation for adolescent idiopathic scoliosis
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Iatrogenic flattening of lumbar lordosis in patients with adolescent idiopathic scoliosis (AIS) was a major downside of first generation instrumentation. Current instrumentation systems allow a three-dimensional scoliosis correction, but flattening of lumbar lordosis remains a significant problem which is associated with decreased health-related quality of life. This study sought to identify risk factors for loss of lumbar lordosis in patients who had surgical correction of AIS with the use of segmental instrumentation.
Patients were included if they had surgical correction for AIS with segmental pedicle screw instrumentation Lenke type 1 or 2 and if they had a minimum follow-up of 24 months. Two groups were created, based on the average loss of lumbar lordosis. The two groups were then compared and multivariate analysis was performed to identify parameters that correlated to loss of lumbar lordosis.
Four hundred and seventeen patients were analyzed for this study. The average loss of lumbar lordosis at 24 months follow-up was an increase of 10° lordosis for group 1 and a decrease of 15° for group 2. Risk factors for loss of lumbar lordosis included a high preoperative lumbar lordosis, surgical decrease of thoracic kyphosis, and the particular operating surgeon. The lowest instrumented vertebra or spinopelvic parameters were two of many parameters that did not seem to influence loss of lumbar lordosis.
This study identified important risk factors for decrease of lumbar lordosis in patients who had surgical treatment for AIS with segmental pedicle screw instrumentation, including a high preoperative lumbar lordosis, surgical decrease of thoracic kyphosis, and factors attributable to a particular operating surgeon that were not quantified in this study.
KeywordsAIS Sagittal balance Segmental instrumentation Pelvic tilt Lumbar lordosis
IRB approval for the study was obtained locally from each contributing institution’s review board, and consent was obtained from each patient prior to data collection. This study was supported by a research grant from DePuy Synthes Spine to the Setting Scoliosis Straight Foundation for the Harms Study Group.
Conflict of interest
- 9.Mac-Thiong JM, Labelle H, Charlebois M, Huot MP, de Guise JA (2003) Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type. Spine (Phila Pa 1976) 28:1404–1409Google Scholar
- 14.Kuklo TR, O’Brien MF, Lenke LG, Polly DW, Sucato DS, Richards BS, Lubicky J, Ibrahim K, Kawakami N, King A (2006) Comparison of the lowest instrumented, stable, and lower end vertebrae in “single overhang” thoracic adolescent idiopathic scoliosis: anterior versus posterior spinal fusion. Spine (Phila Pa 1976) 31:2232–2236CrossRefGoogle Scholar
- 15.Suk S-I, Lee S-M, Chung E-R, Kim J-H, Kim W-J, Sohn HM (2003) Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine (Phila Pa 1976) 28:484–491Google Scholar
- 16.Newton PO, Faro FD, Lenke LG, Betz RR, Clements DH, Lowe TG, Haher TR, Merola AA, D’Andrea LP, Marks M, Wenger DR (2003) Factors involved in the decision to perform a selective versus nonselective fusion of Lenke 1B and 1C (King-Moe II) curves in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 28:S217–S223CrossRefGoogle Scholar
- 17.Newton PO, Yaszay B, Upasani VV, Pawelek JB, Bastrom TP, Lenke LG, Lowe T, Crawford A, Betz R, Lonner B (2010) Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 35:1365–1370Google Scholar