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Risk Factors for Coronal Decompensation After Posterior Spinal Instrumentation and Fusion in Adolescent Idiopathic Scoliosis

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Abstract

Study Design

Retrospective review of multicenter data set with adolescent idiopathic scoliosis (AIS) patients with at least 2 years of follow-up after posterior spinal instrumentation and fusion (PSIF).

Objectives

The purpose of this study is to investigate risk factors for coronal decompensation 2 years after PSIF for AIS.

Summary of Background Data

Coronal decompensation is a potential complication of spinal instrumentation for AIS. This can result in problems requiring revision surgery.

Methods

Demographic, clinical, and radiographic measures were reviewed on 890 identified patients. Coronal decompensation was defined as a change farmer away from midline from 6 weeks postoperatively to 2 years in any one of the following radiographic parameters: change in coronal balance >2 cm; change in coronal position of the lowest instrumented vertebra (LIV) >2 cm; change in thoracic trunk shift >2 cm; or change in LIV tilt angle > 10°. Patients with decompensation were compared to those without. The relationship between the LIV and lowest end vertebra (LEV) was examined as an independent variable.

Results

Two years postoperation, 6.4% (57/890) of patients exhibited coronal decompensation. Multivariate regression revealed that decompensated patients were twice as likely to be male, have lower preoperative Risser score, and lower percentage major curve correction. The relationship between the LIV and LEV as well as quality of life surveys were not significantly different between decompensated and nondecompensated patients at 2 years.

Conclusions

Two years after PSIF, 6.4% of patients with AIS exhibit radiographic coronal decompensation. Although this study did not demonstrate a significant association between the relationship of LIV and LEV and decompensation 2 years postoperation, results of this study indicate that skeletal immaturity, male gender, and less correction of the major curve may be related to higher rates of coronal decompensation.

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Authors and Affiliations

  1. Division of Pediatric Orthopedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, 10032, USA

    Jaime A. Gomez MD, Hiroko Matsumoto PHDC, David P. Roye Jr MD & Michael G. Vitale MD, MPH

  2. Department of Orthopedics, Tufts Medical Center, Boston, MA, 02111, USA

    Nicholas D. Colacchio MD

  3. Division of Pediatric Orthopedic Surgery, New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Medical Center, New York, NY, 10032, USA

    David P. Roye Jr MD & Michael G. Vitale MD, MPH

  4. Department of Pediatric Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX, 75219, USA

    Daniel J. Sucato MD & B. Stephens Richards MD

  5. Department of Orthopedic Surgery, Children’s Hospital Boston, Boston, MA, 02115, USA

    John B. Emans MD

  6. Department of Orthopedic Surgery, Children’s Hospital Colorado, Aurora, CO, 80045, USA

    Mark A. Erickson MD

  7. Department of Orthopedic Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA

    James O. Sanders MD

  8. Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA

    Lawrence G. Lenke MD

Authors
  1. Jaime A. Gomez MD
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  2. Hiroko Matsumoto PHDC
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  3. Nicholas D. Colacchio MD
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  4. David P. Roye Jr MD
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  5. Daniel J. Sucato MD
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  6. B. Stephens Richards MD
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  7. John B. Emans MD
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  8. Mark A. Erickson MD
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  9. James O. Sanders MD
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  10. Lawrence G. Lenke MD
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  11. Michael G. Vitale MD, MPH
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Corresponding author

Correspondence to Hiroko Matsumoto PHDC.

Additional information

Author disclosures: JAG (none); HM (nonfinancial support from Spinal Deformity Study Group, during the conduct of the study; grants from Scoliosis Research Society, grants from Pediatric Orthopedic Society of North America, grants from Children’s Spine Foundation (Grant no.: CWSD005, CWSD0004, CWSD0022, CWSD0026, CWSD0049), grants from Cerebral Palsy International Research Foundation (CPIRF Grant no.: R-808-12), grants from AOSpine, outside the submitted work); NDC (Spinal Deformity Study Group, during the conduct of the study); DPR (Spinal Deformity Study Group, during the conduct of the study; nonfinancial support from Stryker, grants from Scoliosis Research Society, grants from Pediatric Orthopaedic Society of North America, grants from Cerebral Palsy International Research Foundation, other from International Society of Orthopaedic Surgery and Traumatology, nonfinancial support from Children’s Spine Foundation (Grant no.: CWSD005, CWSD0004, CWSD0022, CWSD0026, CWSD0049), grants from Chest Wall and Spine Deformity Research Foundation, grants from AOSpine, grants from Orthopaedic Research and Education Foundation, grants and nonfinancial support from Medtronic, grants from OMeGA (Grant no.: 001167, nosh5532NO, 000786), grants from Biomet, nonfinancial support from Broadwater [Biomet, Synthes, Stryker, Medtronic, K2], outside the submitted work); DJS (none); BSR (Wolters Kluwer HealthdLippincott Williams & Wilkins, other from Pfizer, outside the submitted work; and board member/committee member, Scoliosis Research Society; Medical/Orthopaedic Publications Editorial Governing Board, Journal of Pediatric Orthopaedics); JBE (Medtronics spine, other from Synthes spine, outside the submitted work); MAE (none); JOS (Grants from Children’s Spine Foundation (Grant no.: CWSD005, CWSD0004, CWSD0022, CWSD0026, CWSD0049), grants from POSNA, grants from National Institute of Arthritis and Musculoskeletal and Skin Diseases (Grant no.: 2RO1AR052113), outside the submitted work; stock owner of Abbott Labs, GE, Hospira, and Abbvie); LGL (Grants from Axial Biotech, grants from DePuy-Synthes, grants from AOSpine/SRS/Norton Healthcare, other from AOSpine, other from John and Marcella Fox Research Agreement, personal fees from Medtronic, personal fees from K2M, personal fees from DePuy-Synthes Spine, personal fees from Medtronic, personal fees from Quality Medical Publishing, outside the submitted work); MGV (Spinal Deformity Study Group, during the conduct of the study; other from AAP Section on Orthopaedics, personal fees, nonfinancial support and other from CWSDSG, personal fees from Stryker, personal fees from Biomet, grants from AOSpine, grants from Children’s Spine Foundation (Grant no.: CWSD005, CWSD0004, CWSD0022, CWSD0026, CWSD0049), grants from Orthopaedic Research and Education Foundation, grants from SRS, grants and other from POSNA, grants and nonfinancial support from Medtronic, grants from OMeGA, nonfinancial support from Broadwater [Biomet, Syntes, Stryker, Medtronic, K2], nonfinancial support from FoxPSDSG, outside the submitted work).

This study was performed through the Spinal Deformity Study Group (SDSG), which was funded by Medtronic Sofamor Danek.

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Gomez, J.A., Matsumoto, H., Colacchio, N.D. et al. Risk Factors for Coronal Decompensation After Posterior Spinal Instrumentation and Fusion in Adolescent Idiopathic Scoliosis. Spine Deform 2, 380–385 (2014). https://doi.org/10.1016/j.jspd.2014.05.001

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  • DOI: https://doi.org/10.1016/j.jspd.2014.05.001

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