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Restoration of thoracic kyphosis in adolescent idiopathic scoliosis with patient-specific rods: did the preoperative plan match postoperative sagittal alignment?

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Abstract

Purpose

To determine if the planned sagittal profile for thoracic kyphosis (TK) restoration was achieved after adolescent idiopathic scoliosis (AIS) surgery using a novel hybrid construct with apical double bands and precontoured patient-specific rods (PSR) made according to the detailed surgical plan for the desired sagittal plane.

Methods

AIS patients with a Lenke type 1–4 primary right thoracic curve who underwent corrective surgery by a single surgeon and had minimum 24-month follow-up were analyzed retrospectively from a prospective database. All patients underwent simultaneous translation on two rods with apical double bands and PSR. Clinical outcomes in terms of sagittal 2D TK (T4–T12), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), PI–LL mismatch, rod angle, and rod deflection were compared between preoperative, planned, and 24-month data, while 3D apical rotation, 3D TK (T5–T12), sagittal thoracolumbar angle, degree of curvature at L1–L4 and L4–S1, proximal junctional angle, and distal junctional angle were compared at baseline and at 6 and 24 months postoperatively. SRS-22 questionnaire scores were obtained at baseline and 24 months postoperatively.

Results

Forty-eight patients were included. Study patients had a median coronal thoracic curve of 62.7° preoperatively and 22.4° at 24-month follow-up (p < 0.001). Median TK gain was 6.5° for the entire cohort (n = 48) and 19.1° in the Lenke type 1 and 2 hypokyphotic subgroup (n = 14). Both groups had no significant changes between planned and 24-month TK (p = 0.068 and p = 0.943, respectively), rod angle (p = 0.776 and p = 0.548, respectively), or rod deflection (p = 0.661 and p = 0.850, respectively). For the overall study cohort, median LL gain was 7.0° (p < 0.001), 3D apical derotation was 10.7° (p < 0.001), and change in 3D TK was 36° (p < 0.001). No instance of proximal junctional kyphosis was observed. SRS-22 scores for pain, self-image, and satisfaction differed significantly between the preoperative and 24-month follow-up time-points.

Conclusions

With sagittal plane planning, desired TK, improved reciprocal changes in LL, and minimal changes in rod shape can be achieved in patients with AIS.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Materials availability

UNiD HUB 3.14.5 (2021).

Code availability

JASP Team (2021). JASP (0.15.0.0), Jasp-stats.org.

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Acknowledgements

We thank Dr. Lois W. Sayrs, PhD, for assisting with the statistical analyses, and Dr. Rachel Davis, PhD, for reviewing and revising this manuscript.

Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Children’s Hospital of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA

    Evelyn S. Thomas, Noah Boyer, Hossein Aziz & Afshin Aminian

  2. Department of Orthopedic Surgery, Kettering Health Dayton, Dayton, OH, USA

    Evelyn S. Thomas

  3. Department of Orthopedic Surgery, Community Memorial Hospital, Ventura, CA, USA

    Andrew Meyers

  4. Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Hossein Aziz

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Contributions

Afshin Aminian, MD, Andrew Meyers, DO, and Hossein Aziz, DO, MPH, contributed to conceptualization; Afshin Aminian, MD, Andrew Meyers, DO, and Hossein Aziz, DO, MPH, contributed to methodology; Afshin Aminian, MD, Evelyn S. Thomas, DO, Noah Boyer, BS, Andrew Meyers, DO, and Hossein Aziz, DO, MPH, contributed to formal analysis and investigation; Afshin Aminian, MD, and Evelyn S. Thomas, DO, contributed to writing—original draft preparation; Evelyn S. Thomas, DO, Afshin Aminian, MD, and Andrew Meyers, DO, contributed to writing—review and editing; Afshin Aminian, MD, contributed to supervision.

Corresponding author

Correspondence to Evelyn S. Thomas.

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Conflict of interest

Dr. Afshin Aminian, MD, receives royalties from and consults for Medicrea. All other authors have no relevant financial or non-financial interests to disclose.

Consent to participate

Informed consent was obtained from all individual participants in this study for inclusion in the HARMS database and all studies formulated from the obtained data.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board (IRB) of Children’s Hospital of Orange County approved this study.

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Thomas, E.S., Boyer, N., Meyers, A. et al. Restoration of thoracic kyphosis in adolescent idiopathic scoliosis with patient-specific rods: did the preoperative plan match postoperative sagittal alignment?. Eur Spine J 32, 190–201 (2023). https://doi.org/10.1007/s00586-022-07437-y

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