Skip to main content

Advertisement

SpringerLink
Log in

Unintended Change of Physiological Lumbar Lordosis and Pelvic Tilt After Posterior Spinal Instrumentation and Fusion for Adolescent Idiopathic Scoliosis: How Much Is Too Much?

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Retrospective review of prospective multicenter adolescent idiopathic scoliosis (AIS) database.

Objectives

To investigate the effect of decreased lumbar lordosis (LL) on measured pelvic tilt (PT) after posterior spinal instrumentation and fusion for AIS and to test the hypothesis that lumbar spinal fusion resulting in mismatched LL is associated with increased PT.

Summary of Background Data

Interaction between the spine and pelvis highly influences global sagittal alignment (GSA). In adults, correlation between health-related quality of life measures and LL proportional to a patient-specific pelvic incidence (PI) has been established, although the implications of poor sagittal alignment are less well-defined in AIS. This observation warrants further examination of regional spine contour and its relation to the pelvis in AIS.

Methods

The authors queried a prospective multicenter database for AIS patients who underwent posterior spinal instrumentation and fusion with lowest instrumented vertebra between L2 and L5 and identified 155 patients with minimum 2 years’ follow-up. Lumbar lordosis (T12eS1), LL within fusion, LL below fusion, GSA, PT, and PI were measured preoperatively and at 2 years. Change in PT was compared between patients with matched or mismatched LL based on a common clinical definition (LL 5 PI + 10) and a research-driven model (LL 5 0.56 PI + 33.43).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bridwell KH. Surgical treatment of idiopathic adolescent scoliosis. Spine (Phila Pa 1976) 1999;24:2607–16.

    Article  CAS  Google Scholar 

  2. Majdouline Y, Aubin CE, Robitaille M, et al. Scoliosis correction objectives in adolescent idiopathic scoliosis. J Pediatr Orthop 2007;27:775–81.

    Article  Google Scholar 

  3. Roach JW, Weinstein SL, Dolan LA, et al. Adolescent idiopathic scoliosis. Lancet 2008;371:1527–37.

    Article  Google Scholar 

  4. Schwab F, Patel A, Ungar B, et al. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 2010;35:2224–31.

    Article  Google Scholar 

  5. Cil A, Yazici M, Uzumcugil A, et al. The evolution of sagittal segmental alignment of the spine during childhood. Spine (Phila Pa 1976) 2005;30:93–100.

    Article  Google Scholar 

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

    Article  Google Scholar 

  7. Voutsinas SA, MacEwen GD. Sagittal profiles of the spine. Clin Orthop Relat Res 1986;210:235–42.

    Google Scholar 

  8. Mangione P, Gomez D, Senegas J. Study of the course of the incidence angle during growth. Eur Spine J 1997;6:163–7.

    Article  CAS  Google Scholar 

  9. Betz RR, Harms J, Clements DH, et al. Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idio-pathic scoliosis. Spine (Phila Pa 1976) 1999;24:225–39.

    Article  CAS  Google Scholar 

  10. Edwards CC, Lenke LG, Peelle M, et al. Selective thoracic fusion for adolescent idiopathic scoliosis with C modifier lumbar curves: 2- to 16-year radiographic and clinical results. Spine (Phila Pa 1976) 2004;29:536–46.

    Article  Google Scholar 

  11. Patel PN, Upasani VV, Bastrom TP, et al. Spontaneous lumbar curve correction in selective thoracic fusions of idiopathic scoliosis: a comparison of anterior and posterior approaches. Spine (Phila Pa 1976) 2008;33:1068–73.

    Article  Google Scholar 

  12. Moe JH. A critical analysis of methods of fusion for scoliosis; an evaluation in two hundred and sixty-six patients. J Bone Joint Surg Am 1958;40:529–54.

    Article  Google Scholar 

  13. Potter BK, Kuklo TR, Lenke LG. Radiographic outcomes of anterior spinal fusion versus posterior spinal fusion with thoracic pedicle screws for treatment of Lenke type I adolescent idiopathic scoliosis curves. Spine (Phila Pa 1976) 2005;30:1859–66.

    Article  Google Scholar 

  14. 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 

  15. Dubousset J. Three-Dimensional analysis of the scoliotic deformity. In: Weinstein SL, ed. Pediatric Spine: Principles and Practice. New York, NY: Raven Press, 1994; 479–496

    Google Scholar 

  16. Berthonnaud E, Dimnet J, Roussouly P, Labelle H. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 2005;18:40–7.

    Article  Google Scholar 

  17. Jackson RP, Hales C. Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers. Spine (Phila Pa 1976) 2000;25:2808–15.

    Article  CAS  Google Scholar 

  18. Legaye J, Duval-Beaupere 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 

  19. Rajnics P, Templier A, Skalli W, et al. The association of sagittal spinal and pelvic parameters in asymptomatic persons and patients with isthmic spondylolisthesis. J Spinal Disord Tech 2002;15: 24–30.

    Article  Google Scholar 

  20. Schwab F, Lafage V, Boyce R, et al. Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position. Spine (Phila Pa 1976) 2006;31:E959–67.

    Article  Google Scholar 

  21. Vaz G, Roussouly P, Berthonnaud E, Dimnet J. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 2002;11:80–7.

    Article  CAS  Google Scholar 

  22. Mac-Thiong JM, 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 

  23. Legaye J, Duval-Beaupere G. Sagittal plane alignment of the spine and gravity: a radiological and clinical evaluation. Acta Orthop Belg 2005;71:213–20.

    Google Scholar 

  24. Rose PS, Bridwell KH, Lenke LG, et al. Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine (Phila Pa 1976) 2009;34:785–91.

    Article  Google Scholar 

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

    Article  Google Scholar 

  26. The Clinical Data Experts. http://www.phdx.com/. Accessed January 15, 2015.

  27. SurgimapSpinedThe Physician Driven Imaging Solution. http://www.surgimap.com/. Accessed January 15, 2015.

  28. Descamps H, Commare-Nordmann M, Marty C, et al. Modification of pelvic angle during the human growth [in French]. Biom Hum Anthr 1999;17:59–63.

    Google Scholar 

  29. Tanguay F, Mac-Thiong JM, de Guise JA, Labelle H. Relation between the sagittal pelvic and lumbar spine geometries following surgical correction of adolescent idiopathic scoliosis. Eur Spine J 2007;16:531–6.

    Article  Google Scholar 

  30. 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 

  31. Charlebois M, Mac-Thiong JM, Huot MP, et al. Relation between the pelvis and the sagittal profile in adolescent idiopathic scoliosis: the influence of curve type. Stud Heal Technol Inf 2002;91:140–3.

    Google Scholar 

  32. Cheng I. Point of view: spinopelvic parameters in postfusion flatback deformity patients. Spine J 2009;9:672–3.

    Article  Google Scholar 

  33. Gottfried ON, Daubs MD, Patel AA, et al. Spinopelvic parameters in postfusion flatback deformity patients. Spine J 2009;9:639–47.

    Article  Google Scholar 

  34. Sarwahi V, Boachie-Adjei O, Backus SI, Taira G. Characterization of gait function in patients with postsurgical sagittal (flatback) deformity: a prospective study of 21 patients. Spine (Phila Pa 1976) 2002;27:2328–37.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway Avenue, 8 North, New York, NY, USA

    Hiroko Matsumoto MA, Nicholas D. Colacchio MD, Evan D. Sheha BS, David P. Roye MD & Michael G. Vitale MD, MPH

  2. Department of Orthopaedic Surgery, New York University Medical School, New York, NY, USA

    Frank J. Schwab MD & Virginie Lafage PhD

Authors
  1. Hiroko Matsumoto MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicholas D. Colacchio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frank J. Schwab MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Virginie Lafage PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Evan D. Sheha BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David P. Roye MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael G. Vitale MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroko Matsumoto MA.

Additional information

Author disclosures: NDC (other from Spinal Deformity Study Group, during the conduct of the study); HM (non-financial support from Spinal Deformity Study Group, during the conduct of the study; grants from Children’s Spine Foundation [CWSD005, CWSD0004, CWSD0022, CWSD0026, CWSD0049], Scoliosis Research Society, Pediatric Orthopedic Society of North America, Cerebral Palsy International Research Foundation [Grant #R-808-12], AOSpine, outside the submitted work; travel expenses reimbursed by Broadwater); FJS (consultant for Medtronic; payment for services and royalties from Medtronic; grants from ISSG, NIH, Scoliosis Research Society, DePuy, MSD, AO; holds stock in Nemaris Inc.; personal fees from Nemaris, Inc., MSD, DePuy, K2M, MSD; patent for MSD with royalties paid; patent pending for K2M, Nemaris, Inc.); VL (consultant for Medtronic; payment for service from Medtronic and DepuySpine; holds stock in Nemaris, Inc.; grants from Scoliosis Research Society, DePuy, ISSG, NIH, outside the submitted work; personal fees from Nemaris, Inc., MSD, MSD, DePuy, K2M); EDS (non-financial support from Spinal Deformity Study Group, during the conduct of the study); DPR (consultant for Stryker; grants from Children’s Spine Foundation [CWSD005, CWSD0004, CWSD0022, CWSD0026, CWSD0049], Scoliosis Research Society, Pediatric Orthopedic Society of North America, Biomet, OMeGA [Grants # rjir7201RJ, nosh5532NO, 001167, 000786], AOSpine, Orthopaedic Research and Education Foundation, Medtronic, Cerebral Palsy International Research Foundation [Grant #R-808-12]; travel expenses reimbursed by Medtronic, CWSDSG, Broadwater; other from Spinal Deformity Study Group, International Society of Orthopaedic Surgery and Traumatology, during the conduct of the study; non-financial support from Stryker, Chest Wall and Spine Deformity Study Group, Broadwater, Biomet, Synthes, Medtronic, K2, outside the submitted work); MGV (member of AAP Section on Orthopaedics, Children’s Spine Study Group Board of Directors; consultant for Stryker, Biomet; grants from Children’s Spine Foundation [CWSD005, CWSD0004, CWSD0022, CWSD0026, CWSD0049], Scoliosis Research Society, Pediatric Orthopedic Society of North America, Biomet, OMeGA Medical Grants Association [Grants # rjir7201RJ, nosh5532NO, 001167, 000786], AOSpine, Orthopaedic Research and Education Foundation, Medtronic; recipient of royalties from Biomet; travel and accommodations reimbursed by Medtronic, Children’s Spine Foundation, Broadwater, John and Marcella Fox Research Agreement; other from Spinal Deformity Study Group, during the conduct of the study; other from AAP Section on Orthopaedics; personal fees, non-financial support, and other from CWSDSG; personal fees from Stryker, Biomet, Medtronic; non-financial support from Medtronic, Broadwater, Biomet, Synthes, Stryker, K2; non-financial support from FoxPSDSG, outside the submitted work).

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsumoto, H., Colacchio, N.D., Schwab, F.J. et al. Unintended Change of Physiological Lumbar Lordosis and Pelvic Tilt After Posterior Spinal Instrumentation and Fusion for Adolescent Idiopathic Scoliosis: How Much Is Too Much?. Spine Deform 3, 180–187 (2015). https://doi.org/10.1016/j.jspd.2014.08.010

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2014.08.010

Search

Navigation