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Global malalignment in adolescent idiopathic scoliosis: the axial deformity is the main driver

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Abstract

Purpose

To evaluate the global alignment of non-operated subjects with adolescent idiopathic scoliosis.

Method

A total of 254 subjects with AIS and 64 controls underwent low dose biplanar X-rays and had their spine, pelvis, and rib cage reconstructed in 3D. Global alignment was measured in the sagittal and frontal planes by calculating the OD-HA angle (between C2 dens to hip axis with the vertical). Subjects with AIS were classified as malaligned if the OD-HA was > 95th percentile relative to controls.

Results

The sagittal OD-HA in AIS remained within the normal ranges. In the frontal plane, 182 AIS were normally aligned (Group 1, OD-HA = 0.9°) but 72 were malaligned (Group 2, OD-HA = 2.9°). Group 2 had a more severe spinal deformity in the frontal and horizontal planes compared to Group 1 (Cobb: 42 ± 16° vs. 30 ± 18°; apical vertebral rotation AVR: 19 ± 10° vs. 12 ± 7°, all p < 0.05). Group 2 subjects were mainly classified as Lenke 5 or 6. 19/72 malaligned subjects had a mild deformity (Cobb < 30°) but a progressive scoliosis (severity index ≥ 0.6). The frontal OD-HA angle was found to be mainly determined (adjusted-R2 = 0.22) by the apical vertebral rotation and secondarily by the Lenke type.

Conclusions

This study showed that frontal malalignment is more common in distal major structural scoliosis and its main driver is the apical vertebral rotation. This highlights the importance of monitoring the axial plane deformity in order to avoid worsening of the frontal global alignment.

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Acknowledgements

This research was funded by the University of Saint-Joseph (grant FM300). The funding sources did not intervene in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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Authors and Affiliations

  1. Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Damascus Street, Beirut, Lebanon

    Mohamad Karam, Ismat Ghanem, Nour Khalil, Maria Saadé, Céline Chaaya, Ali Rteil, Elma Ayoub, Eddy Saad, Khalil Kharrat & Ayman Assi

  2. Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France

    Claudio Vergari, Wafa Skalli & Ayman Assi

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  1. Mohamad Karam
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Correspondence to Ayman Assi.

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MK, IG, CV, NK, MS, CC, AR, EA, MF, EJ, ES, KK, WS and AA declare that they have no conflict of interest related to this study.

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Karam, M., Ghanem, I., Vergari, C. et al. Global malalignment in adolescent idiopathic scoliosis: the axial deformity is the main driver. Eur Spine J 31, 2326–2338 (2022). https://doi.org/10.1007/s00586-021-07101-x

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