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Cervical sagittal alignment in Lenke 1 adolescent idiopathic scoliosis and assessment of its alteration with surgery: a retrospective, multi-centric study

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Abstract

Purpose

To document baseline cervical sagittal characteristics in Lenke 1 adolescent idiopathic scoliosis (AIS) patients and assess the alteration in these parameters with surgery.

Methods

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.

Results

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.

Conclusion

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.

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References

  1. 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

  2. Stokes IA, Bigalow LC, Moreland MS (1987) Three-dimensional spinal curvature in idiopathic scoliosis. J Orthop Res 5:102–113

    Article  CAS  Google Scholar 

  3. 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

    Article  Google Scholar 

  4. Glassman SD, Bridwell K, Dimar JR et al (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029

    Article  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  Google Scholar 

  7. 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

    Article  Google Scholar 

  8. 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

    Article  Google Scholar 

  9. 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

    Article  CAS  Google Scholar 

  10. 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

    Article  Google Scholar 

  11. 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

    Article  CAS  Google Scholar 

  12. 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

    Article  Google Scholar 

  13. 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

    Article  Google Scholar 

  14. 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

    Article  Google Scholar 

  15. 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

    Article  CAS  Google Scholar 

  16. Moskowitz A, Moe JH, Winter RB, Binner H (1980) Long-term follow-up of scoliosis fusion. J Bone Jt Surg Am 62:364–376

    Article  CAS  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. 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

    Article  Google Scholar 

  19. 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

  20. Angevine PD, McCormick PC (2007) The importance of sagittal balance: how good is the evidence? J Neurosurg Spine 6:101–103

    Article  Google Scholar 

  21. 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

    Article  PubMed  PubMed Central  Google Scholar 

  22. Yagi M, Iizuka S, Hasegawa A et al (2014) Sagittal cervical alignment in adolescent idiopathic scoliosis. Spine Deform 2:122–130

    Article  Google Scholar 

  23. 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

    Article  Google Scholar 

  24. 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

    Article  Google Scholar 

  25. 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

    Article  Google Scholar 

  26. 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

    Article  Google Scholar 

  27. 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

    Article  Google Scholar 

  28. 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

    Article  Google Scholar 

  29. 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

    Article  Google Scholar 

  30. 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

    Article  Google Scholar 

  31. 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

    Article  Google Scholar 

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Funding

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Authors and Affiliations

  1. All India Institute of Medical Sciences, New Delhi, India

    Bhavuk Garg, Nishank Mehta, Anupam Gupta & Pon Aravindhan A. Sugumar

  2. Ganga Hospital, Coimbatore, India

    Ajoy Prasad Shetty

  3. Kothari Medical Centre, Kolkata, India

    Saumyajit Basu & Somashekhar Doddabhadre Gowda

  4. Ganga Hospital, Coimbatore, India

    Sridhar Jakkepally

  5. Mallika Spine Centre, Guntur, India

    J. Naresh Babu

  6. Indian Spinal Injury Centre, New Delhi, India

    Harvinder Singh Chhabra

Authors
  1. Bhavuk Garg
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  2. Nishank Mehta
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  3. Anupam Gupta
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  4. Pon Aravindhan A. Sugumar
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  5. Ajoy Prasad Shetty
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  6. Saumyajit Basu
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  7. Sridhar Jakkepally
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  8. Somashekhar Doddabhadre Gowda
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  9. J. Naresh Babu
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  10. Harvinder Singh Chhabra
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Contributions

Concepts: BG, NM, AG, APS, SB, SJ, SDG, JNB, HSC; Design: BG, NM, AG, APS, SB; Definition of intellectual conten: BG, NM, PAS, SJ, SDG; Literature search: NM, AG, PAS, SJ, SDG; Data acquisition: BG, NM, AG, PAS, APS, SB, SJ, SDG, JNB, HSC; Data analysis: NM, AG, APS, SB, SJ, SDG; Statistical analysis: NM, AG, PAS; Manuscript preparation: NM; Manuscript editing: BG, NM, AG, APS, SB, HSC; Manuscript review: BG, NM, AG, PAS, APS, SB, SJ, SDG, JNB, HSC; Approval of final manuscript: BG, NM, AG, PAS, APS, SB, SJ, SDG, JNB, HSC; Agree to be accountable for all aspects of work: BG, NM, AG, PAS, APS, SB, SJ, SDG, JNB, HSC.

Corresponding author

Correspondence to Nishank Mehta.

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Conflict of interest

None of the authors report a conflict of interest for this study.

Ethical approval

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.

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Patients signed informed consent regarding publishing their data and photographs.

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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 9, 1559–1568 (2021). https://doi.org/10.1007/s43390-021-00366-8

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