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Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

European Spine Journal volume 21, pages 1964–1971 (2012)Cite this article

Abstract

Purpose

Surgical adolescent idiopathic scoliosis (AIS) management can be associated with loss of thoracic kyphosis and a secondary loss of lumbar lordosis leading to iatrogenic flatback. Such conditions are associated with poorer clinical outcomes during adulthood. The aim of this study was to evaluate sagittal plane reciprocal changes after posterior spinal fusion in the setting of AIS.

Methods

Thirty consecutive adolescents (mean age 14.6 years) with AIS Lenke 1, 2 or 3 were included in this retrospective study with 2 year follow-up. Full-spine standing coronal and lateral radiographs were obtained preoperatively, at 3 and 24 months postoperatively. Coronal Cobb angle, thoracic kyphosis (TK) and lumbar lordosis (LL) were measured. Surgical procedure was similar in all the cases, with use of pedicular screws between T11 and the lowest instrumented vertebra (≥L2), sublaminar hooks applied in compression at the upper thoracic level and sub-laminar bands and clamps in the concavity of the deformity. Statistical analysis was done using t test and Pearson correlation coefficient.

Results

Between preoperative and last follow-up evaluations a significant reduction of Cobb angle was observed (53.6° vs. 17.2°, p < 0.001). A significant improvement of the instrumented thoracic kyphosis, TK (19.7° vs. 26.2°, p < 0.005) was noted, without difference between 3 and 24 months postoperatively. An improvement in lumbar lordosis, LL (43.9° vs. 47.3°, p = 0.009) was also noted but occurred after the third postoperative month. A significant correlation was found between TK correction and improvement of LL (R = 0.382, p = 0.037), without correlation between these reciprocal changes and the amount of coronal correction.

Conclusion

Results from this study reveal that sagittal reciprocal changes occur after posterior fusion when TK is restored. These changes are visible after 3 months postoperatively, corresponding to a progressive adaptation of patient posture to the surgically induced alignment. These changes are not correlated with coronal plane correction of the deformity. In the setting of AIS, TK restoration is a critical goal and permits favorable postural adaptation. Further studies will include pelvic parameters and clinical scores in order to evaluate the impact of the noted reciprocal changes.

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Acknowledgments

Association pour le Développement des Recherches Biologiques et Médicales (A. DE.RE.M).

Conflict of interest

JL Jouve consultant Zimmer.

Author information

Affiliations

  1. Ecole Doctorale 463, Sciences du mouvement humain, UMR CNRS 6233, Université Aix-Marseille, Marseille, France

    B. Blondel, G. Bollini & J. L. Jouve

  2. Pediatric Orthopedic Department, Timone Children Hospital, Université Aix-Marseille, 264 rue Saint Pierre, 13005, Marseille, France

    B. Blondel, G. Bollini & J. L. Jouve

  3. Spine Division, Hospital for Joint Diseases, New York University, New York, USA

    B. Blondel, V. Lafage & F. Schwab

  4. Maimonides Medical Center, Brooklyn, New York, USA

    J. P. Farcy

Authors
  1. B. Blondel
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  2. V. Lafage
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  3. F. Schwab
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  4. J. P. Farcy
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  6. J. L. Jouve
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Correspondence to B. Blondel.

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Blondel, B., Lafage, V., Schwab, F. et al. Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis. Eur Spine J 21, 1964–1971 (2012). https://doi.org/10.1007/s00586-012-2399-4

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  • DOI: https://doi.org/10.1007/s00586-012-2399-4

Keywords

  • Adolescent idiopathic scoliosis
  • Sagittal alignment
  • Reciprocal changes
  • Posterior fusion
  • Thoracic kyphosis