Three-dimensional analysis of the sagittal profile in surgically treated Lenke 5 curves in adolescent idiopathic scoliosis


Study design



To determine how the pre- and postoperative three-dimensional (3D) sagittal profiles of Lenke 5 curves in idiopathic scoliosis patients compare to unaffected controls.

Summary of background data

Prior research evaluating the sagittal plane of Lenke 5 (thoracolumbar/lumbar) curves in 2D suggests that the major curve is hypolordotic.


Patients with Lenke 5 curves treated with thoracolumbar/lumbar posterior fusion who had biplanar radiography (with 3D reconstruction) preoperatively (Pre) and 2+ years postoperatively (PO2Y) were included. A cohort of similarly aged controls (C) without spinal pathology was identified. The following 3D sagittal measurements were compared both pre- and postoperatively to controls: T1–T10, T10–L3, L3–S1, and pelvic incidence (PI). Kyphosis is designated by positive values, and lordosis by negative values.


Nineteen Lenke 5 patients and 125 controls were included. Preoperatively, Lenke 5 patients were hypokyphotic relative to controls from T1 to T10 (30° ± 13° vs. 42° ± 9°, p < 0.001) and hyperlordotic from T10 to L3 (− 26° ± 15° vs. − 13° ± 12°, p < 0.001). Lenke 5 spines were less lordotic from L3 to S1 (− 41° ± 9° vs. − 47° ± 7°, p = 0.004). PI was similar between groups (Lenke 5 Pre: 48° ± 13°, C: 46° ± 10°, p = 0.49). Postoperatively, the area of principal deformity (T10–L3) remained hyperlordotic (PO2Y: − 23° ± 10° vs. C: − 13° ± 12°, p < 0.001). The proximal and distal uninstrumented segments demonstrated spontaneous sagittal correction, becoming similar to controls: T1–T10 (PO2Y: 41° ± 12° vs. C: 42° ± 9°, p = 0.421) and L3–S1 (PO2Y: − 48° ± 9° vs. C: − 47° ± 7°, p = 0.56).


When measured in 3D, Lenke 5 curves were more lordotic than controls in the periapical region of the major coronal curve. Posterior correction improved sagittal alignment, including spontaneous sagittal correction of the unfused segments. However, ~ 10° of hyperlordosis persisted in the instrumented/fused T12–L3 segment. Intraoperative correction strategies should take this preoperative increase in 3D sagittal deformity into account during rod contouring as well as compression/distraction to restore more normal sagittal alignment.

Level of evidence


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Funding to support this study was received from the Rady Children’s Hospital Assaraf Family Fund and from research grants to Setting Scoliosis Straight Foundation from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive and Zimmer Biomet in support of Harms Study Group research.

Author information




Design: KS, BY, TB, VVU, PON. Data acquisition, analysis and/or interpretation of work: KS, RCC, BY, TB, VVU, PON. Manuscript drafting and/or critically revising: KS, RCC, BY, TB, VVU, PON. Final approval: KS, RCC, BY, TB, VVU, PON.

Corresponding author

Correspondence to Peter O. Newton.

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Shen, K., Clement, R.C., Yaszay, B. et al. Three-dimensional analysis of the sagittal profile in surgically treated Lenke 5 curves in adolescent idiopathic scoliosis. Spine Deform (2020).

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  • Adolescent idiopathic scoliosis
  • Sagittal alignment
  • Three dimensional
  • Lenke 5 curve
  • Hyperlordosis