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Sagittal Cervical Alignment in Adolescent Idiopathic Scoliosis

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Abstract

Study Design

Retrospective case series of surgically treated adolescent scoliosis patients.

Objectives

To assess the radiographic changes of cervical kyphosis and identify the possible factors affecting postoperative sagittal cervical kyphosis in surgically treated patients with adolescent idiopathic scoliosis.

Summary of Background Data

Cervical kyphosis is a well-recognized phenomenon in patients with adolescent idiopathic scoliosis. Despite recent reports, the prevalence, radiographic changes, and possible factors affecting postoperative sagittal cervical kyphosis are controversial.

Materials and Methods

A retrospective review of a single-center database was performed on 133 consecutive patients with adolescent idiopathic scoliosis treated with long instrumented (more than 5 levels) spine fusion (minimum, 2 years; mean, 3.3 years; range, 2 to 5.5 years). A total of 89 patients met all of the inclusion criteria. Preoperative and postoperative radiographic measurements and patient demographics were investigated.

Results

Postoperative cervical kyphosis was observed in 46 patients. Cobb angle decreased from 48.1° ± 13.1° to 15.4° ± 11.1° at the final follow-up. Cervical kyphosis significantly decreased from 5.5° ± 8.9° preoperatively to −1.5° ± 8.9° at the final follow-up. No difference was observed for T2–T5, T5–T12, lumbar lordosis, sacral slope, pelvic incidence, pelvic tilt, and sagittal vertical axis during the follow-up. Notably, T2 sagittal tilt was significantly increased from preoperatively to the final follow-up. Pearson correlation coefficient test showed a strong correlation between postoperative cervical lordosis and T2 sagittal tilt (r = 0.73; p <.001).

Conclusions

Despite the significant increase of cervical lordosis, 85% of patients still have a kyphotic or less lordotic cervical spine. The strong positive association between cervical lordosis and T2 sagittal tilt suggests that the sagittal cervical alignment of adolescent idiopathic scoliosis patients is closely related to the global sagittal spine balance rather than thoracic kyphosis.

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References

  1. Cho KJ, Lenke LG, Bridwell KH, et al. Selection of the optimal distal fusion level in posterior instrumentation and fusion for thoracic hyperkyphosis: the sagittal stable vertebra concept. Spine (Phila Pa 1976) 2009;34:765–70.

    Article  Google Scholar 

  2. Kim YJ, Bridwell KH, Lenke LG, et al. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976) 2007;32:2189–97.

    Article  Google Scholar 

  3. Stokes JA, Bigalow LC, Moreland MS. Three-dimensional spinal curvature in idiopathic scoliosis. J Orthop Res 1987;5:102–13.

    Article  CAS  PubMed  Google Scholar 

  4. Kojima T, Kurokawa T. Quantitation of three-dimensional deformity of idiopathic scoliosis. Spine (Phila Pa 1976) 1992;17:S22–9.

    Article  CAS  Google Scholar 

  5. Dickson RA, Lawton JO, Archer IA, et al. The pathogenesis of idiopathic scoliosis: biplanar spinal asymmetry. J Bone Joint Surg Br 1984;66:8–15.

    Article  CAS  PubMed  Google Scholar 

  6. Winter RB, Lovell WW, Moe JH. Excessive thoracic lordosis and loss of pulmonary function in patients with idiopathic scoliosis. J Bone Joint Surg Am 1975;57:972–7.

    Article  CAS  PubMed  Google Scholar 

  7. Bridwell KH, Betz R, Capelli AM, et al. Sagittal plane analysis in idiopathic scoliosis patients treated with Cotrel-Dubousset instrumentation. Spine (Phila Pa 1976) 1990;15:644–9.

    Article  CAS  Google Scholar 

  8. Halm H, Castro WH, Jerosch J, et al. Sagittal plane correction in King-classified idiopathic scoliosis patients treated with Cotrel-Dubousset instrumentation. Acta Orthop Belg 1995;61:294–301.

    CAS  PubMed  Google Scholar 

  9. Edgar MA, Metha MH. Long-term follow-up of fused and unfused idiopathic scoliosis. J Bone Joint Surg Br 1988;70:712–6.

    Article  CAS  PubMed  Google Scholar 

  10. Hosman AJ, Langeloo DD, de Kleuver M, et al. Analysis of the sagittal plane after surgical management for Scheuermann’s disease: a view on overcorrection and the use of an anterior release. Spine (Phila Pa 1976) 2002;27:167–75.

    Article  Google Scholar 

  11. Stagnara P, De Mauroy JC, Dran G, et al. Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine (Phila Pa 1976) 1982;7:335–42.

    Article  CAS  Google Scholar 

  12. Duval-Beaupère G, Legaye J. Composante sagittale de la statique rachidienne. Rev Rhum 2004;71:105–19.

    Article  Google Scholar 

  13. Mac-Thiong JM, Labelle H, Charlebois M, et al. Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type. Spine (Phila Pa 1976) 2003;28:1404–9.

    Google Scholar 

  14. McCance SE, Denis F, Lonstein JE, et al. Coronal and sagittal balance in surgically treated adolescent idiopathic scoliosis with the King II curve pattern: a review of 67 consecutive cases having selective thoracic arthrodesis. Spine (Phila Pa 1976) 1998;23:2063–73.

    Article  CAS  Google Scholar 

  15. Newton PO, Yaszay B, Upasani VV, et al. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2010;35:1365–70.

    Article  Google Scholar 

  16. Upasani VV, Tis J, Bastrom T, et al. Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis: how do these two curve types differ? Spine (Phila Pa 1976) 2007;32:1355–9.

    Article  Google Scholar 

  17. Hilibrand AS, Tannenbaum DA, Graziano GP, et al. The sagittal alignment of the cervical spine in adolescent idiopathic scoliosis. J Pediatr Orthop 1995;15:627–32.

    Article  CAS  PubMed  Google Scholar 

  18. Kimura T, Uno K. Sagittal alignment of the cervical spine in adolescent idiopathic scoliosis, Poster presented at: 37th Annual Meeting of The Scoliosis Research Society, Seattle, WA, USA, September 18–21, 2002.

    Google Scholar 

  19. Canavese F, Turcot K, De Rosa V, et al. Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Eur Spine J 2011;20:1141–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lee SH, Son ES, Seo EM, et al. Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment. Spine J 2013 Sep 7. pii:S1529e9430(13)00745-6. https://doi.org/10.1016/j.spinee.2013.06.059. [Epub ahead of print].

    Google Scholar 

  21. Lenke LG, Betz RR, Harms J, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 2001;83:1169–81.

    Article  CAS  Google Scholar 

  22. Harrison DE, Harison DD, Cailliet R, et al. Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis. Spine (Phila Pa 1976) 2000;25:2072–8.

    Article  CAS  Google Scholar 

  23. McAviney J, Schulz D, Bock R, et al. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther 2005;28:187–93.

    Article  PubMed  Google Scholar 

  24. Basmajian JV, Deluca DJ. Muscles alive. 5th ed. Baltimore: Williams & Wilkins; 1985.

    Google Scholar 

  25. Kuntz CIV, Shaffrey CI, Ondra SL, et al. Spinal deformity: a new classification derived from neutral upright spinal alignment measurements in asymptomatic juvenile, adolescent, adult, and geriatric individuals. Neurosurgery 2008;63(3 Suppl):25–39.

    PubMed  Google Scholar 

  26. Kuntz CIV, Levin LS, Ondra SL, et al. Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine 2007;6:104–12.

    Article  PubMed  Google Scholar 

  27. Neal CJ, McClendon J, Halpin R, et al. Predicting ideal spinopelvic balance in adult spinal deformity. J Neurosurg Spine 2011;15:82–91.

    Article  PubMed  Google Scholar 

  28. Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 2005;30:682–8.

    Article  Google Scholar 

  29. Lowenstein JE, Matsumoto H, Vitale MG, 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 

  30. Yagi M, King AB, Boachie-Adjei O. Incidence, risk factors and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years follow-up. Spine (Phila Pa 1976) 2012;37:1479–89.

    Article  Google Scholar 

  31. Yagi M, Akilah KB, Boachie-Adjei O. Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Spine (Phila Pa 1976) 2011;361:60–8.

    Article  Google Scholar 

  32. Okada E, Matsumoto M, Ichihara D, et al. Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers. Eur Spine J 2009;18:1644–51.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bailey DK. The normal cervical spine in infants and children. Radiology 1952;59:712–9.

    Article  CAS  PubMed  Google Scholar 

  34. de Jonge T, Dubousset JF, Illés T. Sagittal plane correction in idiopathic scoliosis. Spine (Phila Pa 1976) 2002;27:754–60.

    Article  Google Scholar 

  35. Erkan S, Yercan HS, Okcu G, et al. The influence of sagittal cervical profile, gender and age on the thoracic kyphosis. Acta Orthop Belg 2010;76:675–80.

    PubMed  Google Scholar 

  36. Gore DR. Roentgenographic findings in the cervical spine in asymptomatic persons: a ten-year follow-up. Spine (Phila Pa 1976) 2001;26:2463–6.

    Article  CAS  Google Scholar 

  37. Grob D, Frauenfelder H, Mannion AF. The association between cervical spine curvature and neck pain. Eur Spine J 2007;16:669–78.

    Article  CAS  PubMed  Google Scholar 

  38. Harrison DD, Harrison DE, Janik TJ, et al. Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine (Phila Pa 1976) 2004;29:2485–92.

    Article  Google Scholar 

  39. Cohen J. Statistical power analysis for the behavioral sciences. Philadelphia: Routledge; 1998.

    Google Scholar 

  40. Helliwell PS, Evans PF, Wright V. The straight cervical spine: does it indicate muscle spasm? J Bone Joint Surg Br 1994;6:103–6.

    Article  Google Scholar 

  41. Ofiram E, Garvey TA, Schwender JD, et al. Cervical degenerative changes in idiopathic scoliosis patients who underwent long fusion to the sacrum as adults: incidence, severity, and evolution. J Orthop Traumatol 2009;10:27–30.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Propst-Proctor SL, Bleck EE. Radiographic determination of lordosis and kyphosis in normal and scoliotic children. J Pediatr Orthop 1983;3:344–6.

    Article  CAS  PubMed  Google Scholar 

  43. Lykissas MG, Jain VV, Nathan ST, et al. Mid- to long-term outcomes in adolescent idiopathic scoliosis after instrumented posterior spinal fusion: a meta-analysis. Spine (Phila Pa 1976) 2013;38:E113–9.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, National Center for Musculoskeletal Disorders, Murayama Medical Center, 2-37-1 Gakuen, Musashi-Murayama City, Tokyo, Japan

    Mitsuru Yagi MD, PhD, Shingo Iizuka MD, Atsushi Hasegawa MD, Narihito Nagoshi MD, PhD, Kanehiro Fujiyoshi MD, PhD, Shinjiro Kaneko MD, PhD, Masakazu Takemitsu MD, PhD, Masanobu Shioda MD, PhD & Masafumi Machida MD, PhD

Authors
  1. Mitsuru Yagi MD, PhD
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  2. Shingo Iizuka MD
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  3. Atsushi Hasegawa MD
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  4. Narihito Nagoshi MD, PhD
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  5. Kanehiro Fujiyoshi MD, PhD
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  6. Shinjiro Kaneko MD, PhD
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  7. Masakazu Takemitsu MD, PhD
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  8. Masanobu Shioda MD, PhD
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  9. Masafumi Machida MD, PhD
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Corresponding author

Correspondence to Mitsuru Yagi MD, PhD.

Additional information

Author disclosures: MY (none); AH (none); NN (none); SI (none); KF (none); SK (none); Main thoracic (none); MM (none); MS (none); MM (none).

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Yagi, M., Iizuka, S., Hasegawa, A. et al. Sagittal Cervical Alignment in Adolescent Idiopathic Scoliosis. Spine Deform 2, 122–130 (2014). https://doi.org/10.1016/j.jspd.2013.11.002

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  • DOI: https://doi.org/10.1016/j.jspd.2013.11.002

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