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Spinopelvic morphology impacts on postoperative proximal junctional kyphosis in congenital scoliosis with thoracolumbar hemivertebrae

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Abstract

Purpose

It aims to investigate the lumbar and pelvic morphology in congenital scoliosis with thoracolumbar hemivertebrae and its impact on proximal junctional kyphosis (PJK) incidence after hemivertebra resection and short fusion.

Methods

23 congenital scoliosis patients with thoracolumbar hemivertebra aged between 10 and 18 years were enrolled in the retrospective study. Spinopelvic sagittal parameters were analyzed on whole-spine standing lateral radiographs preoperatively, one-week postoperatively and at the final follow-up. Pearson correlations were calculated for local kyphosis (LK), lumbar and pelvic morphology parameters. Binary logistic regression and receiver operating characteristics (ROC) curve analysis were performed to identify the risk factors for PJK.

Results

Thoracolumbar hemivertebra caused LK of 29.2° ± 17.3°, an increased lumbar lordosis (LL) (-64.7° ± 16.3°), lower LL apex (52.2% at L5), and small pelvic incidence (PI) (36.8° ± 6.6°). LK was correlated with lumbar morphology parameters, including LL (r = − 0.837), upper arc of LL (LLUA) (r = − 0.879), thoracolumbar kyphosis (TLK) (r = 0.933), thoracic kyphosis (TK) (r = 0.762) and TK apex (TKA) (r = − 0.749). Surgical treatment improved the lumbar morphology, but not pelvic morphology. At the final follow-up, LL had returned to its preoperative value (p = 0.158). PJK occurred in 30.4% of cases as a compensatory mechanism. Preoperatively, significant differences of parameters between non-PJK and PJK groups were observed in LK and TLK. Binary logistic regression identified three independent risk factors for PJK: preoperative LLA (OR = 0.005, 95%CI = 0.000–0.287, p = 0.011), preoperative TLK (OR = 1.134, 95%CI = 1.001–1.286, p = 0.048), and preoperative lumbar lordosis morphology type (OR = 5.507, 95%CI = 1.202–25.227, p = 0.028). However, residual LK after surgery was not correlated with PJK incidence. ROC curve analysis verified that preoperative TLK > 22.59° was associated with increased PJK incidence after surgery.

Conclusions

Lumbar morphology changes as a compensatory mechanism beneath the thoracolumbar hemivertebra. However, a stable pelvis tends to allow the LL to return to its preoperative value. PJK occurred as a cranial compensatory mechanism for increasing LL and corrected TLK. A larger TLK (> 22.59°) was an independent risk factor for PJK incidence in patients with type 2 and 3A lumbar lordosis morphology.

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Data availability

The datasets analyzed in the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the Department of Imaging in Shandong Provincial Hospital affiliated to Shandong First Medical University for providing the image data.

Funding

This article receives funding from Natural Science Foundation of Shandong Province (Award Number ZR2020QH264), Clinical Medical Science and Technology Innovation Plan of Jinan (Award Number 202019202).

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Authors and Affiliations

  1. Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Jinan, Shandong, China

    Yang Li, Chenggui Zhang, Jianmin Sun & Guodong Wang

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  2. Chenggui Zhang
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Contributions

Yang Li: drafted the work; acquisition, analysis, and measure of data. approved the version to be published. agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Chenggui Zhang: acquisition, analysis approved the version to be published. agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Jianmin Sun: revised it critically for important intellectual content; conception or design of the work approved the version to be published. agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Guodong Wang: design of the work; drafted the work. approved the version to be published. agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Guodong Wang.

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Li, Y., Zhang, C., Sun, J. et al. Spinopelvic morphology impacts on postoperative proximal junctional kyphosis in congenital scoliosis with thoracolumbar hemivertebrae. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00877-0

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