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Flatback Revisited: Reciprocal Loss of Lumbar Lordosis Following Selective Thoracic Fusion in the Setting of Adolescent Idiopathic Scoliosis

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Abstract

Study Design

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

Objective

To investigate the relationship between iatrogenic loss of thoracic kyphosis (TK) after selective thoracic posterior spinal instrumentation and fusion (PSIF) for AIS with straightening of lumbar lordosis (LL).

Summary of Background Data

Segmental PSIF has become the standard of care for surgical treatment of severe AIS. Studies show that adults with flattening of TK and LL can develop pain and dysfunction associated with flatback syndrome. Analysis of post-fusion sagittal alignment is lacking in the AIS population.

Methods

Query of prospective multicenter database for AIS patients with Lenke 1, 2, or 3 curves who underwent selective thoracic PSIF (lowest instrumented vertebra equal or cephalad toL1) identified 123 patientswith aminimum of 2 years’ follow-up. Thoracic kyphosis (T5–T12),LL(T12–S1), and global sagittal alignment were measured preoperatively and at 2 years postoperatively. Health-related quality of life measures were examined.

Results

A total of 31% of patients had loss of TK and 42% lost LL. Patients with decreased TK had significantly higher rates of decreased LL (68%) than patients without decreased TK (31%). Multivariate regression confirmed that TK had significant predictive effect on LL (p <.001). Specifically, change in TK of 2° was associated with roughly 3° change in LL. There were no significant associations between changes in TK or LL and health-related quality of life.

Conclusions

Loss of TK occurs commonly in selective fusion for AIS. This loss of kyphosis is strongly associated with reciprocal loss of LL. Spinal fusion can have unintended effects on sagittal alignment; these effects may have consequences that remain to be fully elucidated.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, 800 North, New York, NY, 10032, USA

    Hiroko Matsumoto MA, David P. Roye MD & Michael G. Vitale MD, MPH

  2. Department of Epidemiology, Mailmen School of Public Health at Columbia University, 722 West 168th Street, New York, NY, 10032, USA

    Hiroko Matsumoto MA

  3. Department of Orthopaedics, Tufts University Medical Center, Boston, MA, USA

    Nicholas D. Colacchio MD

  4. Department of Orthopaedic Surgery, New York University Medical School, 301 East 17th Street, New York, NY, 10003, USA

    Frank J. Schwab MD & Virginie Lafage PhD

Authors
  1. Hiroko Matsumoto MA
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  2. Nicholas D. Colacchio MD
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  3. Frank J. Schwab MD
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  4. Virginie Lafage PhD
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  5. David P. Roye MD
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  6. Michael G. Vitale MD, MPH
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Corresponding author

Correspondence to Hiroko Matsumoto MA.

Additional information

Author disclosures: HM (non-financial support from Spinal Deformity Study Group during the conduct of the study; grants from Scoliosis Research Society, Pediatric Orthopedic Society of North America, Children’s Spine Foundation (grant, CWSD005, CWSD0004, CWSD0022, CWSD0026, CWSD0049), Cerebral Palsy International Research Foundation (grant, #R-808-12),AOSpine, outside the submitted work; support for travel and accommodations from Spinal Deformity Study Group to attend meetings in relation to this article);NDC(other from Spinal Deformity Study Group, during the conduct of the study); FJS (personal fees from Nemaris Inc., MSD, DePuy, K2M; grants from DePuy, MSD, AO; personal fees from MSD, Nemaris Inc., K2M, personal fees from Nemaris Inc, outside the submitted work; patent from MSD with royalties paid; patent pending from K2M, Nemaris Inc.); VL (personal fees from Nemaris Inc., MSD, MSD, DePuy, K2M, Nemaris Inc.; grants from DePuy, ISSG, SRS, NIH, outside the submitted work); DPR (other from Spinal Deformity Study Group, during the conduct of the study; non-financial support from Stryker; grants from Scoliosis Research Society, Pediatric Orthopaedic Society of North America, Cerebral Palsy International Research Foundation (grant, #R-808-12), Children’s Spine Foundation (grant, CWSD005, CWSD0004, CWSD0022, CWSD0026, CWSD0049), AOSpine, Orthopedic Research and Education Foundation, OMeGA Medical (grants, rjir7201RJ, nosh5532NO, 001167, 000786), from Biomet; other from International Society of Orthopaedic Surgery andTraumatology; non-financial support from ChestWall and Spine Deformity Study Group; grants and non-financial support from Medtronic, non-financial support from Broadwater (Biomet, Synthes, Stryker, Medtronic, K2), outside the submitted work; support for travel and accommodations from Spinal Deformity Study Group to attend meetings in relation to this article; honorarium in relation to Spinal Deformity Study Group meetings); MGV (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; grants from AOSpine, CWSDRF, OREF, SRS, OMeGA; grants and other from POSNA; grants and non-financial support from Medtronic; non-financial support from Broadwater (Biomet, Synthes, Stryker, Medtronic, K2), FoxPSDSG, outside the submitted work; support for travel and accommodations from Spinal Deformity Study Group to attend meetings in relation to this article; honorarium in relation to Spinal Deformity Study Group meetings).

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Matsumoto, H., Colacchio, N.D., Schwab, F.J. et al. Flatback Revisited: Reciprocal Loss of Lumbar Lordosis Following Selective Thoracic Fusion in the Setting of Adolescent Idiopathic Scoliosis. Spine Deform 3, 345–351 (2015). https://doi.org/10.1016/j.jspd.2015.01.004

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  • DOI: https://doi.org/10.1016/j.jspd.2015.01.004

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