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The 3D Sagittal Profile of Thoracic Versus Lumbar Major Curves in Adolescent Idiopathic Scoliosis

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Abstract

Study Design

Retrospective.

Objective

To compare the 3D sagittal profile of patients with main thoracic or thoracolumbar/lumbar adolescent idiopathic scoliosis (AIS) to a normal cohort.

Summary of Background Information

Thoracic AIS is often associated with a loss of kyphosis. Classically, this measure has been made in 2D, which may underestimate the true sagittal deformity.

Methods

Biplanar upright radiographs were obtained on 152 primary thoracic (TH: Lenke 1–4), 50 primary thoracolumbar/lumbar (TL/ L: Lenke 5–6) curves, and 89 normal controls (NC). 3D spinal reconstructions were created using sterEOS software. MATLAB code was used to create segmental measurements of kyphosis/lordosis for each vertebral and disc segment from T1 to S1 in the local coordinate system of each motion segment. Comparisons were made between groups for the 3D summed segmental measures (Tl–T5, T5–T12, T12–S1), pelvic incidence, sacral slope, and pelvic tilt.

Results

Mean 2D Cobb was 57°±12° (range 40°–115°) for TH curves and 52°±9° (range 37°–75°) for TL/L curves. Significant differences in 3D sagittal measures were found between the 3 groups. Post hoc tests revealed significant differences at T1–T5, TH<NC, and TL/L<NC. All groups differed from each other from T5–T12, with the least kyphosis in TH curves. T12–S1 lordosis was significantly greater in TH and TL/L curves compared with NC. Lumbar lordosis extended proximally an average of one segment in AIS compared to normal spines (T11 vs T12). Pelvic incidence, sacral slope, and pelvic tilt were significantly greater for TH curves compared to NC.

Conclusions

There is a substantial average loss of thoracic kyphosis (~15°–25°) for both primary thoracic and primary thoracolumbar/ lumbar AIS curves compared to normal adolescents. Three-dimensional assessment of scoliosis allows the “true” deformity to be measured by correcting for error due to out-of-plane measurement associated with conventional 2D measurements.

Level of Evidence

Level II, prognostic.

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Author information

Authors and Affiliations

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

    Peter O. Newton MD, Tracey P. Bastrom MA, Joshua D. Doan MEng & Fredrick G. Reighard MPH

  2. Department of Orthopaedics, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0021, USA

    Peter O. Newton MD & Emily J. Osborn MD

Authors
  1. Peter O. Newton MD
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  2. Emily J. Osborn MD
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  3. Tracey P. Bastrom MA
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  4. Joshua D. Doan MEng
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  5. Fredrick G. Reighard MPH
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Corresponding author

Correspondence to Peter O. Newton MD.

Additional information

Author disclosures: PON (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 the National Institutes of Health and the Orthopaedic Research, Education Foundation [OREF], and EOS Imaging; grants and other from Scoliosis Research Society [SRS]; personal fees from Thieme Publishing, Ethicon Endosurgery, Cubist, and K2M; other from NuVasive, Electrocore, International Orthopedic Think Tank, Orthopediatrics Institutional Support, outside the submitted work; in addition, PON 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, a patent “Screw Placement Guide” (7981117) issued to DePuy Spine, and a patent “Compressor for Use in Minimally Invasive Surgery” (7189244) issued to DePuy Spine), EJO (none), TPB (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), JDD (grants from Setting Scoliosis Straight Foundation, during the conduct of the study), FGR (grants from Setting Scoliosis Straight Foundation, during the conduct of the study).

Study conducted at Rady Children’s Hospital, San Diego, CA.

IRB approval was obtained for this study.

Research support is gratefully acknowledged from the Rady Children’s Foundation Assaraf Family Research Fund and from funding to Setting Scoliosis Straight Foundation from DePuy Synthes Spine and EOS Imaging for Harms Study Group Research.

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Newton, P.O., Osborn, E.J., Bastrom, T.P. et al. The 3D Sagittal Profile of Thoracic Versus Lumbar Major Curves in Adolescent Idiopathic Scoliosis. Spine Deform 7, 60–65 (2019). https://doi.org/10.1016/j.jspd.2018.05.003

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  • DOI: https://doi.org/10.1016/j.jspd.2018.05.003

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