Advertisement

Does curve convexity affect the surgical outcomes of thoracic adolescent idiopathic scoliosis?

  • Wei-Jun Wang
  • Ai-Bing Huang
  • Ze-Zhang Zhu
  • Feng Zhu
  • Xu Sun
  • Yong QiuEmail author
Original Article

Abstract

Background

Major left thoracic (LT) curve is an atypical type in adolescent idiopathic scoliosis (AIS) and showed independent clinical characteristics and natural history compared to major right thoracic (RT) curve. However, it’s unclear whether the convexity of major thoracic curve would affect the surgical outcomes and risk of complications. A retrospective follow-up study was conducted to investigate whether the convexity of major thoracic curve would affect the surgical outcomes of patients with main thoracic AIS.

Methods

Twelve LT-AIS patients underwent corrective spinal instrumentation and fusion were retrieved, and twelve patients with main RT-AIS matched for gender, chronological age, curve type, magnitude and surgical strategy were selected as control. All patients underwent at least 2-year follow-up. The pre- and post-operative radiographic parameters, intraoperative data and functional outcome assessed by Scoliosis Research Society questionnaire 22 (SRS-22) were analyzed and compared between two groups.

Results

Patients with LT- and RT-AIS presented with similar magnitudes of thoracic curves, flexibility, fusion level and correction rate. Compared with RT-AIS, patients with LT-AIS showed longer operation time (average, 364 vs. 348 min) and larger amount intraoperative estimated blood loss (2,060 vs. 1,720 ml) although the differences were not statistically significant (p > 0.05). With at least 2-year follow-up, patients in two groups showed comparable loss of correction, coronal and sagittal balance, and the sagittal profiles. With regard to functional outcome, the scores of five categories of SRS-22 questionnaire were similar between two groups. No neurological or vascular complication was observed in these patients.

Conclusions

The radiographic and functional outcomes of LT-AIS patients underwent operation were comparable to those with RT-AIS. Longer operation time and more intraoperative blood loss may be expected in instrumentation and fusion for patients with LT-AIS, which might be because of the inconvenience on the surgical procedure.

Keywords

Idiopathic scoliosis Adolescent Thoracic Direction Correction 

Notes

Acknowledgments

This work was supported by National Natural Science Foundation of China (81101335), National Post-doctoral Foundation of China (2012M52101062), National Key Clinical Specialty Construction Project in Orthopaedics, and Jiangsu Province’s Key Medical Talents Project (RC2011149).

Conflict of interest

None.

References

  1. 1.
    Coonrad RW, Murrell GA, Motley G et al (1998) A logical coronal pattern classification of 2,000 consecutive idiopathic scoliosis cases based on the scoliosis research society-defined apical vertebra. Spine (Phila Pa 1976) 23:1380–1391CrossRefGoogle Scholar
  2. 2.
    King HA, Moe JH, Bradford DS et al (1983) The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Jt Surg Am 65:1302–1313Google Scholar
  3. 3.
    Weinstein SL, Dolan LA, Cheng JC et al (2008) Adolescent idiopathic scoliosis. Lancet 371:1527–1537PubMedCrossRefGoogle Scholar
  4. 4.
    Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Jt Surg Am 83-A:1169–1181Google Scholar
  5. 5.
    Qiu G, Zhang J, Wang Y et al (2005) A new operative classification of idiopathic scoliosis: a Peking Union Medical College method. Spine (Phila Pa 1976) 30:1419–1426CrossRefGoogle Scholar
  6. 6.
    Hausmann ON, Boni T, Pfirrmann CW et al (2003) Preoperative radiological and electrophysiological evaluation in 100 adolescent idiopathic scoliosis patients. Eur Spine J 12:501–506PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Inoue M, Minami S, Nakata Y et al (2005) Preoperative MRI analysis of patients with idiopathic scoliosis: a prospective study. Spine (Phila Pa 1976) 30:108–114Google Scholar
  8. 8.
    Richards BS, Sucato DJ, Johnston CE et al (2010) Right thoracic curves in presumed adolescent idiopathic scoliosis: which clinical and radiographic findings correlate with a preoperative abnormal magnetic resonance image? Spine (Phila Pa 1976) 35:1855–1860CrossRefGoogle Scholar
  9. 9.
    James JI (1954) Idiopathic scoliosis; the prognosis, diagnosis, and operative indications related to curve patterns and the age at onset. J Bone Jt Surg Br 36-B:36–49Google Scholar
  10. 10.
    McCarver C, Levine D, Velaskis K (1971) Left thoracic curve patterns in idiopathic scoliosis. J Bone Jt Surg Am 53:196Google Scholar
  11. 11.
    Ylikoski M (2005) Growth and progression of adolescent idiopathic scoliosis in girls. J Pediatr Orthop B 14:320–324PubMedCrossRefGoogle Scholar
  12. 12.
    Qiu Y, Zhu F, Wang B et al (2009) Clinical etiological classification of scoliosis: report of 1,289 cases. Orthop Surg 1:12–16PubMedCrossRefGoogle Scholar
  13. 13.
    Elsig JPJ, Kaech DL (2007) Dynamic imaging of the spine with an open upright MRI: present results and future perspectives of fmri. Eur J Orthop Surg Traumatol 17:119–124CrossRefGoogle Scholar
  14. 14.
    Wu L, Qiu Y, Wang B et al (2010) The left thoracic curve pattern: a strong predictor for neural axis abnormalities in patients with “idiopathic” scoliosis. Spine (Phila Pa 1976) 35:182–185CrossRefGoogle Scholar
  15. 15.
    Spiegel DA, Flynn JM, Stasikelis PJ et al (2003) Scoliotic curve patterns in patients with Chiari I malformation and/or syringomyelia. Spine (Phila Pa 1976) 28:2139–2146CrossRefGoogle Scholar
  16. 16.
    Qiu Y, Zhu ZZ, Wang B et al (2008) Radiological presentations in relation to curve severity in scoliosis associated with syringomyelia. J Pediatr Orthop 28:128–133PubMedCrossRefGoogle Scholar
  17. 17.
    Goldberg CJ, Moore DP, Fogarty EE et al (1999) Left thoracic curve patterns and their association with disease. Spine (Phila Pa 1976) 24:1228–1233CrossRefGoogle Scholar
  18. 18.
    Wang W, Zhu Z, Zhu F et al (2012) Different curve pattern and other radiographical characteristics in male and female patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 37:1586–1592CrossRefGoogle Scholar
  19. 19.
    Goldberg CJ, Dowling FE, Fogarty EE (1994) Left thoracic scoliosis configurations. Why so different? Spine (Phila Pa 1976) 19:1385–1389CrossRefGoogle Scholar
  20. 20.
    Soucacos PN, Zacharis K, Gelalis J et al (1998) Assessment of curve progression in idiopathic scoliosis. Eur Spine J 7:270–277PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Chiu YL, Huang TJ, Hsu RW (1998) Curve patterns and etiologies of scoliosis: analysis in a university hospital clinic in Taiwan. Changgeng Yi Xue Za Zhi 21:421–428PubMedGoogle Scholar
  22. 22.
    Gupta R, Sharma R, Vashisht S et al (1999) Magnetic resonance evaluation of idiopathic scoliosis: a prospective study. Australas Radiol 43:461–465PubMedCrossRefGoogle Scholar
  23. 23.
    Bradley LJ, Ratahi ED, Crawford HA et al (2007) The outcomes of scoliosis surgery in patients with syringomyelia. Spine (Phila Pa 1976) 32:2327–2333CrossRefGoogle Scholar
  24. 24.
    Ferguson RL, DeVine J, Stasikelis P et al (2002) Outcomes in surgical treatment of “idiopathic-like” scoliosis associated with syringomyelia. J Spinal Disord Tech 15:301–306PubMedCrossRefGoogle Scholar
  25. 25.
    Sponseller PD, Young AT, Sarwark JF et al (1999) Anterior only fusion for scoliosis in patients with myelomeningocele. Clin Orthop Relat Res 364:117–124PubMedCrossRefGoogle Scholar
  26. 26.
    Wang WJ, Yeung HY, Chu WC et al (2011) Top theories for the etiopathogenesis of adolescent idiopathic scoliosis. J Pediatr Orthop 31:S14–S27PubMedCrossRefGoogle Scholar
  27. 27.
    Lao LF, Chen ZG, Qiu GX et al (2013) Whole-spine magnetic resonance imaging study in healthy Chinese adolescents. Orthop Surg 5:164–170PubMedCrossRefGoogle Scholar
  28. 28.
    Sun X, Qiu Y, Zhu Z et al (2007) Variations of the position of the cerebellar tonsil in idiopathic scoliotic adolescents with a Cobb angle >40°: a magnetic resonance imaging study. Spine (Phila Pa 1976) 32:1680–1686CrossRefGoogle Scholar
  29. 29.
    Cobb J (1948) Outline for the study of scoliosis. In: Instr Course Lect. American Academy of Orthopaedic Surgeons, Ann Arbor, MI, pp 61–75Google Scholar
  30. 30.
    McCance SE, Denis F, Lonstein JE et al (1998) Coronal and sagittal balance in surgically treated adolescent idiopathic scoliosis with the King II curve pattern. A review of 67 consecutive cases having selective thoracic arthrodesis. Spine (Phila Pa 1976) 23:2063–2073CrossRefGoogle Scholar
  31. 31.
    Gelb DE, Lenke LG, Bridwell KH et al (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 20:1351–1358CrossRefGoogle Scholar
  32. 32.
    Kuklo TR, Potter BK, Polly DW Jr et al (2005) Monaxial versus multiaxial thoracic pedicle screws in the correction of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 30:2113–2120CrossRefGoogle Scholar
  33. 33.
    Qiu G, Qiu Y, Zhu Z et al (2011) Re-evaluation of reliability and validity of simplified Chinese version of SRS-22 patient questionnaire: a multicenter study of 333 cases. Spine (Phila Pa 1976) 36:E545–E550CrossRefGoogle Scholar
  34. 34.
    Asher M, Lai SM, Burton D et al (2003) The reliability and concurrent validity of the Scoliosis Research Society-22 patient questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976) 28:63–69CrossRefGoogle Scholar
  35. 35.
    Qiu Y, He YX, Wang B et al (2007) The anatomical relationship between the aorta and the thoracic vertebral bodies and its importance in the placement of the screw in thoracoscopic correction of scoliosis. Eur Spine J 16:1367–1372PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Sucato DJ, Duchene C (2003) The position of the aorta relative to the spine: a comparison of patients with and without idiopathic scoliosis. J Bone Jt Surg Am 85-A:1461–1469Google Scholar
  37. 37.
    Sarlak AY, Buluc L, Sarisoy HT et al (2008) Placement of pedicle screws in thoracic idiopathic scoliosis: a magnetic resonance imaging analysis of screw placement relative to structures at risk. Eur Spine J 17:657–662PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Milbrandt TA, Sucato DJ (2007) The position of the aorta relative to the spine in patients with left thoracic scoliosis: a comparison with normal patients. Spine (Phila Pa 1976) 32:E348–E353CrossRefGoogle Scholar
  39. 39.
    Richards BS, Sucato DJ, Johnston CE et al. (2010) Right thoracic curves in presumed adolescent idiopathic scoliosis: Which clinical and radiographic findings correlate with a preoperative abnormal magnetic resonance image? Spine (Phila Pa 1976) 35:1855–1860Google Scholar
  40. 40.
    Coonrad R, Richardson W, Oakes W (1985) Left thoracic curves can be different. Orthop Trans 9:126–129Google Scholar
  41. 41.
    Ozerdemoglu RA, Denis F, Transfeldt EE (2003) Scoliosis associated with syringomyelia: clinical and radiologic correlation. Spine (Phila Pa 1976) 28:1410–1417Google Scholar
  42. 42.
    Wang W, Zhu Z, Zhu F et al (2008) The changes of relative position of the thoracic aorta after anterior or posterior instrumentation of type I Lenke curve in adolescent idiopathic thoracic scoliosis. Eur Spine J 17:1019–1026PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Wei-Jun Wang
    • 1
  • Ai-Bing Huang
    • 1
  • Ze-Zhang Zhu
    • 1
  • Feng Zhu
    • 1
  • Xu Sun
    • 1
  • Yong Qiu
    • 1
    Email author
  1. 1.Spine SurgeryThe Affiliated Drum Tower Hospital of Nanjing University Medical SchoolNanjingChina

Personalised recommendations