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Sagittal Alignment After Surgical Treatment of Adolescent Idiopathic Scoliosis—Application of the Roussouly Classification

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Abstract

Study Design

Retrospective cohort study.

Objectives

To investigate spinopelvic alignment and spine shape in patients surgically treated for adolescent idiopathic scoliosis (AIS) and to assess the distribution and clinical applicability of the Roussouly classification.

Summary of Background Data

How spinopelvic alignment is affected in AIS patients is not well established. Roussouly et al. proposed a classification based on the sagittal spinal profile and spinopelvic alignment that may have clinical utility in these patients.

Methods

A consecutive cohort of 134 surgically treated AIS patients were included. Whole-spine standing lateral radiographs were analyzed preoperatively, one-week postoperatively and at two-year follow-up. Patients were categorized using the modified Roussouly classification and analyzed for sagittal alignment.

Results

Postoperatively, global thoracic kyphosis (TK) decreased by 2.6° and lumbar lordosis (LL) decreased by 6.2°(p ≤ .012) while Pelvic tilt (PT) increased 1.4° (p = .024). At two-year follow-up, TK and LL had returned to preoperative values (p ≥ .346) while PT had decreased from preoperative 9.7 ± 7.6° to 7.0 ± 7.5° (p > .001). Proximal junctional angle increased from 8.4 ± 5.0° preoperatively to 12.8 ± 8.9 (p < .001). Preoperatively, Roussouly curve types were distributed equally apart from a lower rate of type 1 (12%). At final follow-up, 30% were categorised as type 3 with pelvic anteversion which is considerably higher than the normal adolescent population. Only three patients were type 1 at the final follow-up. Overall, we found a high rate of proximal junctional kyphosis (16%), PI-LL mismatch (60%) and pelvic anteversion (38%). In preoperative type 1 patients, the rate was 50%, 82% and 64%, respectively.

Conclusion

We found that immediate postoperative changes in lordosis and kyphosis were reversed at final follow-up and found evidence of proximal junctional kyphosation and pelvic anteversion as the main compensatory mechanisms. Poor sagittal alignment was frequent in type 1 curves, and surgical treatment may need to be individualized according to the sagittal profile.

Level of Evidence

III

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References

  1. de Kleuver M, Lewis SJ, Germscheid NM, et al. Optimal surgical care for adolescent idiopathic scoliosis: an international consensus. Eur Spine J 2014;23:2603–18.

    Article  Google Scholar 

  2. Pasha S, Aubin C-E, Sangole AP, et al. Three-dimensional spinopelvic relative alignment in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2014;39:564–70.

    Article  Google Scholar 

  3. La Maida GA, Zottarelli L, Mineo GV, Misaggi B. Sagittal balance in adolescent idiopathic scoliosis: radiographic study of spino-pelvic compensation after surgery. Eur Spine J 2013;22(Suppl 6):S859–67.

    Article  Google Scholar 

  4. Hong JY, Kim KW, Suh SW, Park SY, Yang JH. Effect of coronal scoliotic curvature on sagittal spinal shape—analysis of parameters in mature adolescent scoliosis patients. Clin Spine Surg 2017;30:E418–22.

    Article  Google Scholar 

  5. Roussouly P, Labelle H, Rouissi J, Bodin A. 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 2013;22(Suppl 2):S203–15.

    Article  Google Scholar 

  6. Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 1998;7:99–103.

    Article  CAS  Google Scholar 

  7. Hallager DW, Hansen LV, Dragsted CR, et al. A comprehensive analysis of the SRS-Schwab adult spinal deformity classification and confounding variables: a prospective, non-US cross-sectional study in 292 patients. Spine (Phila Pa 1976) 2016;41:E589–97.

    Article  Google Scholar 

  8. Hresko MT, Hirschfeld R, Buerk AA, Zurakowski D. The effect of reduction and instrumentation of spondylolisthesis on spinopelvic sagittal alignment. J Pediatr Orthop 2009;29:157–62.

    Article  Google Scholar 

  9. Kumar M, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 2001;10:314–9.

    Article  CAS  Google Scholar 

  10. Skalli W, Zeller RD, Miladi L, et al. Importance of pelvic compensation in posture and motion after posterior spinal fusion using CD instrumentation for idiopathic scoliosis. Spine (Phila Pa 1976) 2006;31:E359–66.

    Article  Google Scholar 

  11. Roussouly P, Nnadi C. Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 2010;19:1824–36.

    Article  Google Scholar 

  12. Schwab F, Lafage V, Patel A, Farcy JP Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976) 2009;34:1828–33.

    Article  Google Scholar 

  13. Helgeson MD, Shah SA, Newton PO, et al. Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation. Spine (Phila Pa 1976) 2010;35:177–81.

    Article  Google Scholar 

  14. Newton PO, O’Brien MF, Shufflebarger HL, et al. Idiopathic scoliosis: the Harms Study Group treatment guide. 1st ed. New York: Thieme Medical Pulishers; 2010.

  15. Yilmaz G, Borkhuu B, Dhawale AA, et al. Comparative analysis of hook, hybrid, and pedicle screw instrumentation in the posterior treatment of adolescent idiopathic scoliosis. J Pediatr Orthop 2012;32:490–9.

    Article  Google Scholar 

  16. Lowenstein J, Matsumoto H, Vitale M, et al. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976) 2007;32:448–52.

    Article  Google Scholar 

  17. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 2005;30:346–53.

    Article  Google Scholar 

  18. Laouissat F, Sebaaly A, Gehrchen M, Roussouly P. Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J 2017. Epub ahead of print.

  19. Gehrchen M, Ohrt-Nissen S, Hallager DW, Dahl B. A uniquely shaped rod improves curve correction in surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2016;41:1139–45.

    Article  Google Scholar 

  20. Mac-Thiong J-M, Berthonnaud E, Dimar JR, et al. Sagittal alignment of the spine and pelvis during growth. Spine (Phila Pa 1976) 2004;29:1642–7.

    Article  Google Scholar 

  21. Sacramento-Dominguez C, Vayas-Diez R, Coil-Mesa L, et al. Reproducibility measuring the angle of proximal junctional kyphosis using the first or the second vertebra above the upper instrumented vertebrae in patients surgically treated for scoliosis. Spine (Phila Pa 1976) 2009;34:2787–91.

    Article  Google Scholar 

  22. Rothenfluh DA, Mueller DA, Rothenfluh E, Min K. Pelvic incidence—lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J 2015;24:1251–8.

    Article  Google Scholar 

  23. Schwab FJ, Blondel B, Bess S, et al. Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 2013;38: E803–12.

    Article  Google Scholar 

  24. Mac-Thiong J-M, Roussouly P, Berthonnaud E, Guigui P. Sagittal parameters of global spinal balance normative values from a prospective cohort of seven hundred nine caucasian asymptomatic adults. Spine (Phila Pa 1976) 2010;35:1193–8.

    Article  Google Scholar 

  25. Mac-Thiong JM, Labelle H, Berthonnaud E, et al. Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J 2007;16: 227–34.

    Article  Google Scholar 

  26. Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 2011;20(Suppl5):609–18.

    Article  Google Scholar 

  27. Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society—Schwab Adult Spinal Deformity Classification. Spine (Phila Pa 1976) 2012;37:1077–82.

    Article  Google Scholar 

  28. Ohrt-Nissen S, Dragsted CR, Dahl B, et al. A rod construct with differentiated rigidity improves the restoration of thoracic kyphosis in surgical treatment of adolescent idiopathic scoliosis. Neurosurg Focus 2017;43:E6.

    Article  Google Scholar 

  29. Cahill PJ, Wang W, Asghar J, et al. The use of a transition rod may prevent proximal junctional kyphosis in the thoracic spine after scoliosis surgery. Spine (Phila Pa 1976) 2012;37:E687–95.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Spine Unit, University Hospital of Copenhagen, Blegdamsvej 9, København, 2100, Denmark

    Søren Ohrt-Nissen MD, Tanvir Bari MD & Martin Gehrchen MD, PhD

  2. Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital, 6621 Fannin St, Houston, TX, 77030, USA

    Benny Dahl MD, DMSc

Authors
  1. Søren Ohrt-Nissen MD
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  2. Tanvir Bari MD
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  3. Benny Dahl MD, DMSc
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  4. Martin Gehrchen MD, PhD
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Corresponding author

Correspondence to Søren Ohrt-Nissen MD.

Additional information

Author disclosures: SON (grants from K2M, during the conduct of the study; institutional grant from K2M outside the submitted work), TB (none), BD (grants from K2M, grants from Medtronic, during the conduct of the study; institutional grant from K2M outside the submitted work; institutional grant from Medtronic outside the submitted work), MG (institutional grant from K2M outside the submitted work; institutional grant from Medtronic outside the submitted work).

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Ohrt-Nissen, S., Bari, T., Dahl, B. et al. Sagittal Alignment After Surgical Treatment of Adolescent Idiopathic Scoliosis—Application of the Roussouly Classification. Spine Deform 6, 537–544 (2018). https://doi.org/10.1016/j.jspd.2018.02.001

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  • DOI: https://doi.org/10.1016/j.jspd.2018.02.001

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