Outcomes of selective thoracic fusion for Lenke 1 adolescent idiopathic scoliosis: predictors of success from the sagittal plane

Original Article

Abstract

Purpose

To determine the link between the rate of spontaneous lumbar curve correction (SLCC) and the sagittal profile characteristics both before and after selective thoracic fusion in Lenke 1 adolescent idiopathic scoliosis (AIS).

Methods

Sixty-three Lenke 1 B and C were enrolled and followed up to 2 years. Twenty non-scoliotic controls were included. 3D reconstruction of the spine was generated from bi-planar X-rays at pre-operative, first erect post-operative, and the most recent follow-up. The 3D spinal models were used to determine the frontal and sagittal Cobb angles and 3D coordinate of each vertebral centroid. A K-mean cluster analysis allocated patients into two groups based on the rate of SLCC between the pre-operative and the most recent follow-up visits (SLCCHigh and SLCCLow groups). The ratio of the thoracic to lumbar curve apical translations in sagittal plane was determined. ANOVA test compared the sagittal apical translation ratio between the three visits of the AIS clusters and between the AIS groups and controls.

Results

The rate of the SLCC was significantly different between the two clusters: 31% (SLCCLow) versus 76% (SLCCHigh). No significant difference was found between the two clusters pre-operative Cobb angles, kyphosis, and lordosis. The pre-operative ratio of the thoracic to lumbar apical translation in the sagittal plane was significantly lower in SLCCHigh compared to SLCCLow group, a magnitude of 1.2 and 2.2, respectively, p < 0.05.

Conclusion

In Lenke 1, patients with a higher pre-operative sagittal thoracic to lumbar apical translation ratio are associated with lower rate of SLCC at the most recent follow-up.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Adolescent idiopathic scoliosis Selective thoracic fusion Spontaneous lumbar Cobb correction Sagittal alignment Surgical planning 

Notes

Acknowledgements

This study received research Grant funding from Scoliosis Research Society and was approved by the Institutional Review Board. The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest relevant to this submission.

Supplementary material

586_2018_5553_MOESM1_ESM.pptx (337 kb)
Supplementary material 1 (PPTX 336 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Orthopaedic SurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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