Skip to main content

Advertisement

SpringerLink
Log in

Timing of Changes in Three-Dimensional Spinal Parameters After Selective Thoracic Fusion in Lenke 1 Adolescent Idiopathic Scoliosis: Two-Year Follow-up

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

Abstract

Study Design

Retrospective analysis of the prospectively collected data.

Objective

To investigate the relationship between the axial rotation of the unfused lumbar spine and the parameters of the instrumented thoracic spine at varying time points after selective thoracic fusion (STF) in Lenke 1B and 1C adolescent idiopathic scoliosis (AIS).

Summary of Background Data

The impact of STF on the spontaneous lumbar curve correction in AIS has been studied mainly in the frontal planes. The relationship between the spontaneous transverse plane correction of the lumbar spine and the parameters of the fused thoracic spine is not well documented.

Methods

Twenty-one Lenke 1B and 1C patients who had received STF with minimum two years’ follow-up were selected. Thoracic and lumbar Cobb angles, kyphosis, lordosis, and thoracic and lumbar apical vertebrae rotations were measured at preoperative, first-erect, six-month, one-year, and two-year follow-ups. The association between the lumbar apical vertebral rotation and other thoracic and lumbar variables at different time points were determined using regression analysis. The variables significantly predicting the lumbar axial rotation correction at two years were determined from the preceding follow-up visits.

Results

Kyphosis, thoracic Cobb, thoracic apical vertebral rotation, and lumbar Cobb were significantly different between the preoperative and all the postoperative follow-ups (p <.05). At the two-year follow-up, a decrease in thoracic rotation and lumbar Cobb and a higher residual thoracic Cobb were associated with an improved spontaneous lumbar rotation (R2 = 0.41, p <.05). Lumbar rotation at two years was predicted from thoracic derotation and lumbar Cobb at first erect (R2 = 0.30, p <.05).

Conclusion

Spontaneous lumbar curve rotation correction correlated to the fused and unfused spinal parameters in the three anatomic planes. The relationship between thoracic and lumbar rotation persist up to two years after STF. Thoracic derotation is an important factor determining the lumbar rotation correction at two years after STF.

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. Hwang SW, Samdani AF, Gressot LV, et al. Effect of direct vertebral body derotation on the sagittal profile in adolescent idiopathic scoliosis. Eur Spine J 2012;21:31–9.

    Article  Google Scholar 

  2. Lamerain M, Bachy M, Dubory A, et al. All-pedicle screw fixation with 6-mm-diameter cobalt-chromium rods provides optimized sagittal correction of adolescent idiopathic scoliosis. Clin Spine Surg 2016 [Epub ahead of print].

  3. Cecen GS, Gulabi D, Guclu B, et al. Comparison of pedicle screw fixation and hybrid instrumentation in adolescent idiopathic scoliosis. Acta Orthop Traumatol Turc 2016;50:351–5.

    PubMed  Google Scholar 

  4. Mladenov KV, Vaeterlein C, Stuecker R. Selective posterior thoracic fusion by means of direct vertebral derotation in adolescent idiopathic scoliosis: effects on the sagittal alignment. Eur Spine J 2011;20:1114–7.

    Article  Google Scholar 

  5. Lenke LG, Betz RR, Bridwell KH, et al. Spontaneous lumbar curve coronal correction after selective anterior or posterior thoracic fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 1999;24:1663–71; discussion 1672.

    Article  CAS  Google Scholar 

  6. Mizusaki D, Gotfryd AO. Assessment of spontaneous correction of lumbar curve after fusion of the main thoracic in Lenke 1 adolescent idiopathic scoliosis. Rev Bras Ortop 2016;51:83–9.

    Article  Google Scholar 

  7. Edwards 2nd 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 

  8. Crawford 3rd CH, Lenke LG, Sucato DJ, et al. Selective thoracic fusion in Lenke 1C curves: prevalence and criteria. Spine (Phila Pa 1976) 2013;38:1380–5.

    Article  Google Scholar 

  9. Lenke LG, Commentary: postoperative spinal alignment remodeling in Lenke 1C scoliosis treated with selective thoracic fusion. Spine J 2012;12:81–2.

    Article  Google Scholar 

  10. Chang KW, Leng X, Zhao W, et al. Broader curve criteria for selective thoracic fusion. Spine (Phila Pa 1976) 2011;36:1658–64.

    Article  Google Scholar 

  11. Somoskeoy S, Tunyogi-Csapo M, Bogyo C, Illes T. Accuracy and reliability of coronal and sagittal spinal curvature data based on patient-specific three-dimensional models created by the EOS 2D/3D imaging system. Spine J 2012;12:1052–9.

    Article  Google Scholar 

  12. Pomerantz ML, Glaser D, Doan J, et al. Three-dimensional biplanar radiography as a new means of accessing femoral version: a comparitive study of EOS three-dimensional radiography versus computed tomography. Skeletal Radiol 2015;44:255–60.

    Article  Google Scholar 

  13. Illes T, Somoskeoy S. The EOS imaging system and its uses in daily orthopaedic practice. Int Orthop 2012;36:1325–31.

    Article  Google Scholar 

  14. Glaser DA, Doan J, Newton PO. Comparison of 3-dimensional spinal reconstruction accuracy: biplanar radiographs with EOS versus computed tomography. Spine (Phila Pa 1976) 2012;37:1391–7.

    Article  Google Scholar 

  15. Pasha S, Cahill PJ, Dormans JP, Flynn JM. Characterizing the differences between the 2D and 3D measurements of spine in adolescent idiopathic scoliosis. Eur Spine J 2016;25:3137–45.

    Article  Google Scholar 

  16. [Computer program] R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for statistical Computing; 2010.

  17. Blondel B, Lafage V, Schwab F, et al. Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis. Eur Spine J 2012;21:1964–71.

    Article  CAS  Google Scholar 

  18. Hu P, Yu M, Liu X, et al. Analysis of the relationship between coronal and sagittal deformities in adolescent idiopathic scoliosis. Eur Spine J 2016;25:409–16.

    Article  Google Scholar 

  19. 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 

  20. Tao F, Zhao Y, Wu Y, et al. The effect of differing spinal fusion instrumentation on the occurrence of postoperative crankshaft phenomenon in adolescent idiopathic scoliosis. J Spinal Disord Tech 2010;23:e75–80.

    Article  Google Scholar 

  21. Na KH, Harms J, Ha KY, Choi NY. Axial plane lumbar responses after anterior selective thoracic fusion for main thoracic adolescent idiopathic scoliosis. Asian Spine J 2008;2:81–9.

    Article  Google Scholar 

  22. Ilharreborde B, Steffen JS, Nectoux E, et al. Angle measurement reproducibility using EOS three-dimensional reconstructions in adolescent idiopathic scoliosis treated by posterior instrumentation. Spine (Phila Pa 1976) 2011;36:E1306–13.

    Article  Google Scholar 

  23. Humbert L, De Guise JA, Aubert B, et al. 3D reconstruction of the spine from biplanar X-rays using parametric models based on transversal and longitudinal inferences. Med Eng Phys 2009;31:681–7.

    Article  CAS  Google Scholar 

  24. Gille O, Champain N, Benchikh-El-Fegoun A, et al. Reliability of 3D reconstruction of the spine of mild scoliotic patients. Spine (Phila Pa 1976) 2007;32:568–73.

    Article  Google Scholar 

  25. Courvoisier A, Garin C, Vialle R, Kohler R. The change on vertebral axial rotation after posterior instrumentation of idiopathic scoliosis. Childs Nerv Syst 2015;31:2325–31.

    Article  Google Scholar 

  26. Hirsch C, Ilharreborde B, Mazda K. EOS suspension test for the assessment of spinal flexibility in adolescent idiopathic scoliosis. Eur Spine J 2015;24:1408–14.

    Article  Google Scholar 

  27. Czaprowski D, Pawlowska P, Gebicka A, et al. Intra- and interobserver repeatability of the assessment of anteroposterior curvatures of the spine using Saunders digital inclinometer. Ortop Traumatol Rehabil 2012;14:145–53.

    Article  Google Scholar 

  28. Bunnell WP. An objective criterion for scoliosis screening. J Bone Joint Surg Am 1984;66:1381–7.

    Article  CAS  Google Scholar 

  29. Fletcher ND, Hopkins J, McClung A, et al. Residual thoracic hypokyphosis after posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis: risk factors and clinical ramifications. Spine (Phila Pa 1976) 2012;37:200–6.

    Article  Google Scholar 

  30. Fu G, Kawakami N, Goto M, et al. Comparison of vertebral rotation corrected by different techniques and anchors in surgical treatment of adolescent thoracic idiopathic scoliosis. J Spinal Disord Tech 2009;22:182–9.

    Article  Google Scholar 

  31. Vallespir GP, Flores JB, Trigueros IS, et al. Vertebral coplanar alignment: a standardized technique for three dimensional correction in scoliosis surgery: technical description and preliminary results in Lenke type 1 curves. Spine (Phila Pa 1976) 2008;33:1588–97.

    Article  Google Scholar 

  32. Vora V, Crawford A, Babekhir N, et al. A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality. Spine (Phila Pa 1976) 2007;32:1869–74.

    Article  Google Scholar 

  33. Marks M, Newton PO, Petcharaporn M, et al. Postoperative segmental motion of the unfused spine distal to the fusion in 100 patients with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2012;37:826–32.

    Article  Google Scholar 

  34. Bernstein P, Hentschel S, Platzek I, et al. Thoracal flat back is a risk factor for lumbar disc degeneration after scoliosis surgery. Spine J 2014;14:925–32.

    Article  Google Scholar 

  35. Green DW, Lawhorne 3rd TW, Widmann RF, et al. Long-term magnetic resonance imaging follow-up demonstrates minimal transitional level lumbar disc degeneration after posterior spine fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2011;36:1948–54.

    Article  Google Scholar 

  36. Pasha S, Capraro A, Cahill PJ, et al. Bi-planar spinal stereoradiography of adolescent idiopathic scoliosis: considerations in 3D alignment and functional balance. Eur Spine J 2016;25:3234–41.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 34th Street and 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Saba Pasha PhD, John M. Flynn MD & Patrick J. Cahill MD

  2. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, 21218, USA

    Paul D. Sponseller MD

  3. School of Orthopedics, University of Messina, Piazza Pugliatti, 1, 98122, Messina, ME, Italy

    Giuseppe Orlando MD

  4. Department of Orthopedics, Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA, 92123, USA

    Peter O. Newton MD

Authors
  1. Saba Pasha PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John M. Flynn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul D. Sponseller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppe Orlando MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter O. Newton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrick J. Cahill MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Harms Study Group

Corresponding author

Correspondence to Saba Pasha PhD.

Additional information

Author disclosures: Dr Pasha reports grants from SRS. Dr Flynn reports others from Wolters Kluwer Health, others from American Board of Orthopaedic Surgery, Inc. and personal fees from Biomet. Dr Sponseller reports personal fees from DePuy, A Johnson & Johnson Company, grants from A Johnson & Johnson Company, personal fees from Globus Medical, other from Journal of Bone and Joint Surgery, personal fees from Journal of Bone and Joint Surgeryoakstone medical, other from Scoliosis Research Society. Dr Orlando has nothing to disclose. Dr. Newton reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation, other from Rady Children’s Specialists, grants and personal fees from DePuy Synthes Spine, personal fees from Law firm of Carroll, Kelly, Trotter, Franzen & McKenna, personal fees from Law firm of Smith, Haughey, Rice & Roegge, grants from NIH, grants from OREF, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, other from NuVasive, personal fees from Ethicon Endosurgery, other from Electrocore, personal fees from Cubist, other from International Orthopedic Think Tank, other from Orthopediatrics Institutional Support, personal fees from K2M, outside the submitted work; In addition, Dr. Newton has a patent Anchoring systems and methods for correcting spinal deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) issued to DePuy Spine, Inc., a patent Screw placement guide (7981117) issued to DePuy Spine, Inc., and a patent Compressor for use in minimally invasive surgery (7189244) issued to DePuy Spine, Inc.. Dr Cahill reports other from SRS, other from Journal of Bone and Joint Surgery, other from Pediatric Orthopaedic Society of North America, other from spine deformity, personal fees from Biogen, Inc. Setting Scoliosis Straight reports research grants to support Harms Study Group Research from DePuy Synthes Spine, K2M, Inc, EOS Imaging, and Zimmer Biomet. Additional educational funding support received from Ellipse technologies, Globus Medical, Lawall Prosthetics, Medtronic Spinal, NuVasive, Orthopediatrics, SpineGuard, Stryker Spine Midatlantic, Allied Orthopedic Associates, C.D. Denison Orthopaedic Appliance Corp, Mazor Robotics and Theraplay.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pasha, S., Flynn, J.M., Sponseller, P.D. et al. Timing of Changes in Three-Dimensional Spinal Parameters After Selective Thoracic Fusion in Lenke 1 Adolescent Idiopathic Scoliosis: Two-Year Follow-up. Spine Deform 5, 409–415 (2017). https://doi.org/10.1016/j.jspd.2017.04.003

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2017.04.003

Keywords

Search

Navigation