To document baseline cervical sagittal characteristics in Lenke 1 adolescent idiopathic scoliosis (AIS) patients and assess the alteration in these parameters with surgery.
Pre-operative and 2-year postoperative radiographs of 82 Lenke 1 AIS patients recruited from five hospitals were analysed. Selected radiographic parameters capturing regional and global sagittal alignment were measured. Comparison was made between groups based on baseline thoracic kyphosis (TK: TK < 20°, TK ≥ 20°). Pre-operative and postoperative values were compared—the change in each radiographic parameter was correlated with the degree of sagittal and coronal correction.
At baseline, TK was 29.8° ± 16°, cervical lordosis (CL) was − 1° ± 14°, lumbar lordosis (LL) was − 57.1° ± 21°, C2–C7 sagittal vertical axis (SVA) was 16 ± 14 mm and C7–S1 SVA was − 15 ± 28 mm; 44% of patients had cervical kyphosis. Patients with thoracic hypokyphosis had a significantly lower LL and more kyphotic cervical spine compared to those with thoracic normohyperkyphosis. The effect of surgery on TK depended on pre-operative thoracic sagittal alignment—TK increased in patients with thoracic hypokyphosis, but decreased in patients with thoracic normohyperkyphosis. Neither CL nor C2–C7 SVA changed significantly with surgery; 46% of patients still had cervical kyphosis postoperatively.
There is a high incidence of cervical kyphosis at baseline in AIS patients—more so in those with pre-operative thoracic hypokyphosis. Unlike TK, CL is not significantly altered with surgery—improvement in CL correlates weakly with sagittal correction of the structural curve.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Dubousset J (1994) Three-dimensional analysis of the scoliotic deformity. In: Weinstein SL (ed) The pediatric spine: principles and practice. Raven Press Ltd., New York, pp 479–496
Stokes IA, Bigalow LC, Moreland MS (1987) Three-dimensional spinal curvature in idiopathic scoliosis. J Orthop Res 5:102–113
Barrey C, Roussouly P, Perrin G, Le Huec J-C (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 20:626
Glassman SD, Bridwell K, Dimar JR et al (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029
Ilharreborde B (2018) Sagittal balance and idiopathic scoliosis: does final sagittal alignment influence outcomes, degeneration rate or failure rate? Eur Spine J 27:48–58. https://doi.org/10.1007/s00586-018-5472-9
Hwang SW, Samdani AF, Tantorski M et al (2011) Cervical sagittal plane decompensation after surgery for adolescent idiopathic scoliosis: an effect imparted by postoperative thoracic hypokyphosis. J Neurosurg Spine 15:491–496
Newton PO, Yaszay B, Upasani VV et al (2010) Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine 35:1365–1370
Sucato DJ, Agrawal S, O’Brien MF et al (2008) Restoration of thoracic kyphosis after operative treatment of adolescent idiopathic scoliosis: a multicenter comparison of three surgical approaches. Spine 33:2630–2636
Blondel B, Lafage V, Schwab F et al (2012) Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis. Eur Spine J 21:1964–1971
Roussouly P, Labelle H, Rouissi J, Bodin A (2013) Pre-and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults. Eur Spine J 22:203–215
Hilibrand AS, Tannenbaum DA, Graziano GP et al (1995) The sagittal alignment of the cervical spine in adolescent idiopathic scoliosis. J Pediatr Orthop 15:627–632
Canavese F, Turcot K, De Rosa V et al (2011) Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Eur Spine J 20:1141–1148
Ilharreborde B, Vidal C, Skalli W, Mazda K (2013) Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis treated by posteromedial translation. Eur Spine J 22:330–337
Shimizu T, Cerpa M, Lehman RA et al (2019) Reciprocal change in sagittal profiles after adolescent idiopathic scoliosis surgery with segmental pedicle screw construct: a full-body X-ray analysis. Spine 44:1705–1714
Edgar M, Mehta M (1988) Long-term follow-up of fused and unfused idiopathic scoliosis. J Bone Jt Surg Br 70:712–716. https://doi.org/10.1302/0301-620X.70B5.3192566
Moskowitz A, Moe JH, Winter RB, Binner H (1980) Long-term follow-up of scoliosis fusion. J Bone Jt Surg Am 62:364–376
Wang L, Liu X (2017) Cervical sagittal alignment in adolescent idiopathic scoliosis patients (Lenke type 1–6). J Orthop Sci 22:254–259. https://doi.org/10.1016/j.jos.2016.12.006
Lenke LG, Edwards CC, Bridwell KH (2003) The Lenke classification of adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine 28:S199–S207
O’Brien M, Kuklo T, Blanke K, Lenke LG (2008) Clinical Photographs and Radiographic Methodology to Evaluate Spinal Deformity. In: Spinal Deformity Study Group: Radiographic Measurement Manual, 1st ed. Medtronic Sofamor Danek, pp 11–30
Angevine PD, McCormick PC (2007) The importance of sagittal balance: how good is the evidence? J Neurosurg Spine 6:101–103
Pumberger M, Schmidt H, Putzier M (2018) Spinal deformity surgery: a critical review of alignment and balance. Asian Spine J 12:775–783. https://doi.org/10.31616/asj.2018.12.4.775
Yagi M, Iizuka S, Hasegawa A et al (2014) Sagittal cervical alignment in adolescent idiopathic scoliosis. Spine Deform 2:122–130
Hiyama A, Sakai D, Watanabe M et al (2016) Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis: a comparative study of 42 adolescents with idiopathic scoliosis and 24 normal adolescents. Eur Spine J 25:3226–3233
Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353
Dumpa SR, Shetty AP, Aiyer SN et al (2018) Reciprocal changes in sagittal alignment in adolescent idiopathic scoliosis patients following strategic pedicle screw fixation. Asian Spine J 12:300
Ha Y, Schwab F, Lafage V et al (2014) Reciprocal changes in cervical spine alignment after corrective thoracolumbar deformity surgery. Eur Spine J 23:552–559
Berger RJ, Sultan AA, Tanenbaum JE et al (2018) Cervical sagittal alignment and the impact of posterior spinal instrumented fusion in patients with Lenke type 1 adolescent idiopathic scoliosis. J Spine Surg 4:342
Youn MS, Shin JK, Goh TS et al (2016) Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis. Eur Spine J 25:3114–3119
Lowenstein JE, Matsumoto H, Vitale MG et al (2007) Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine 32:448–452
Akbar M, Almansour H, Lafage R et al (2018) Sagittal alignment of the cervical spine in the setting of adolescent idiopathic scoliosis. J Neurosurg Spine 29:506–514
Yeung KH, Man GCW, Lam TP et al (2020) Accuracy on the preoperative assessment of patients with adolescent idiopathic scoliosis using biplanar low-dose stereoradiography: a comparison with computed tomography. BMC Musculoskelet Disord 21:1–10
There is no funding source for this publication/study.
Conflict of interest
None of the authors report a conflict of interest for this study.
Approval was obtained from the Institutional Ethics Committee of All India Institute of Medical Sciences, New Delhi. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Consent to Publish
Patients signed informed consent regarding publishing their data and photographs.
About this article
Cite this article
Garg, B., Mehta, N., Gupta, A. et al. Cervical sagittal alignment in Lenke 1 adolescent idiopathic scoliosis and assessment of its alteration with surgery: a retrospective, multi-centric study. Spine Deform (2021). https://doi.org/10.1007/s43390-021-00366-8
- Adolescent idiopathic scoliosis
- Cervical lordosis
- Cervical spine alignment
- Thoracic kyphosis
- Sagittal alignment
- Spinal balance