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Restoring the ideal Roussouly sagittal alignment in Lenke 5 adolescent idiopathic scoliosis patients: a method for decreasing the risk of proximal junctional kyphosis

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Abstract

Purpose

Although the Roussouly classification has been widely used in surgical planning for adult scoliosis patients, little is known about whether it can be used to guide sagittal correction for adolescent idiopathic scoliosis (AIS) patients. The purpose of this study was to explore whether the Roussouly classification could be used to help surgeons restore the ideal sagittal alignment for AIS patients to avoid the development of proximal junctional kyphosis (PJK).

Methods

In this retrospective cohort study, eighty-seven patients with Lenke 5 AIS who underwent surgery from January 2010 to August 2020 were enrolled and divided into two groups: the PJK group and the non-PJK group. All patients were classified into “current types” and “ideal types” according to two versions of the Roussouly classification, and the mismatch rate was evaluated in terms of the consistency between their current type and ideal type. Student’s t test, Mann‒Whitney U test, Pearson’s Chi-square test, and others were used to compare the two groups regarding patient demographic characteristics (age, sex, Risser sign, etc.) and radiographic parameters (sagittal vertical axis [SVA]; thoracic kyphosis [TK]; thoracolumbar junctional kyphosis [TLK]; lumbar lordosis [LL]; pelvic incidence [PI]; pelvic tilt [PT]; sacral slope [SS]; upper instrumented vertebra [UIV]; lower instrumented vertebra [LIV]; etc.). Multivariate logistic regression with backwards stepwise selection was performed to identify the risk factors for PJK.

Results

PJK was observed in 16 out of 87 patients (18.4%) until the final follow-up. The incidence of PJK was significantly higher in the patients not matching their ideal type than in those who did after surgery (60.9% vs. 3.1%, p = 0.000). The patients with ideal Type 1 had the highest incidence of PJK, while the lowest incidence was observed in patients with ideal Type 2 (50.0% vs. 5.1%, p = 0.000). The PJK group had greater TK, LL, and PI-LL than the non-PJK group before and after surgery. The postoperative PJA in the PJK group was also larger than that in the non-PJK group. Multivariate logistic regression revealed that postoperative Roussouly type mismatch was significantly associated with the occurrence of PJK (OR = 64.2, CI = 9.6–407.1, p = 0.000).

Conclusions

The Roussouly classification could serve as a prognostic tool for PJK in Lenke 5 AIS patients. Corrective surgery should restore sagittal alignment with respect to the patient’s ideal sagittal profile (according to the Roussouly classification based on the PI) to decrease the incidence of PJK in AIS patients.

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Acknowledgements

We greatly appreciate the financial support provided by the National Natural Science Foundation of China (82072386).

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Author notes

  1. Zhuang Zhang and Quan Zhou contributed equally to this study and should be considered co first author.

  2. Yue ming Song and Xi Yang contributed equally to this study and should be considered co corresponding author.

Authors and Affiliations

  1. Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People’s Republic of China

    Zhuang Zhang, Ce Zhu, Li-min Liu, Yue-ming Song & Xi Yang

  2. Department of Surgery of Spine and Spinal Cord, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China

    Quan Zhou

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  1. Zhuang Zhang
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Correspondence to Yue-ming Song or Xi Yang.

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No conflict of interest exits in the submission of this manuscript, and manuscript is approved by all authors for publication. This retrospective study was approved by the Ethics Committee of the West China Hospital (No. 2019–852). The Manuscript submitted does not contain information about medical device(s)/drug(s).

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Zhang, Z., Zhou, Q., Zhu, C. et al. Restoring the ideal Roussouly sagittal alignment in Lenke 5 adolescent idiopathic scoliosis patients: a method for decreasing the risk of proximal junctional kyphosis. Eur Spine J 33, 695–705 (2024). https://doi.org/10.1007/s00586-023-07992-y

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  • DOI: https://doi.org/10.1007/s00586-023-07992-y

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